madman
Super Moderator
Abstract
The term BHCV syndrome^ encompasses several organ- and systemic pathophysiological states, which often recognize autoimmunity or neoplastic evolution in their pathophysiology, as well as chronic HCV infection as trigger. The clinical features of HCV patients are heterogenous, and may include endocrine or metabolic disorders, namely autoimmune thyroiditis, type 2 diabetes mellitus, and erectile/sexual dysfunctions. In this review, we summarize current knowledge on the endocrine/metabolic diseases associated with chronic HCV infection, focusing on the main concepts emerged in the recent literature in this field. The application of this knowledge in everyday clinical practice may be relevant, in order to reinforce a holistic vision of the patient with chronic HCV infection, stimulating in turn a multi-disciplinary approach, thus increasing the probability of early diagnosis, more effective treatments, and a better prognostic outcome.
5 Conclusions
Chronic HCV infection is responsible of a multi-organ, systemic pathological condition whose pathophysiology may include chronic inflammatory-based damage, autoimmune processes, and neoplastic evolution. As a consequence, HCV patients’ clinical picture is not restricted to chronic hepatitis, which presents different severity grades from subclinical inflammation to overt liver cirrhosis. Indeed, several nosographic entities may be associated with chronic HCV infection, ranging from single organ disorders to complex multi-system disorders. The term BHCV syndrome^ was proposed in order to unify all these pathological entities that recognize HCV as the main trigger [1, 2]. As part of HCV syndrome, a few endocrine/ metabolic diseases are nosographically considered, namely AT, type 2 diabetes mellitus, and sexual dysfunction. A subset of each of these diseases may be recognized as HCV-related [1–9].
The fallout of these concepts in everyday clinical practice may be relevant, since it emphasizes the hypothesis of an aetiologic therapy for chronic diseases considered not susceptible of definitive healing, up to date. In particular, the recent introduction of several new antivirals into the physician’s armamentarium has made the hypothesis of a definite treatment more accessible. However, the actual effects of sustained virological response on long term prognosis of HCV-associated autoimmune or neoplastic diseases are not definitely clarified, thus further studies are necessary.
Another important consequence of the identification of HCV syndrome should be the recovery of a holistic vision of the patients with chronic HCV infection, thanks to a multi-disciplinary approach to these patients, leading to a higher probability of early diagnosis, then more effective treatments and a better outcome.
Overall, HCV syndrome remains a useful educational prototype of virus-driven autoimmune and neoproliferative multisystem disorder [1, 2, 77]. The study of HCV syndrome represents one of the most successful research area of translational medicine, in term of aetiopathophysiology understanding and clinical application.
The term BHCV syndrome^ encompasses several organ- and systemic pathophysiological states, which often recognize autoimmunity or neoplastic evolution in their pathophysiology, as well as chronic HCV infection as trigger. The clinical features of HCV patients are heterogenous, and may include endocrine or metabolic disorders, namely autoimmune thyroiditis, type 2 diabetes mellitus, and erectile/sexual dysfunctions. In this review, we summarize current knowledge on the endocrine/metabolic diseases associated with chronic HCV infection, focusing on the main concepts emerged in the recent literature in this field. The application of this knowledge in everyday clinical practice may be relevant, in order to reinforce a holistic vision of the patient with chronic HCV infection, stimulating in turn a multi-disciplinary approach, thus increasing the probability of early diagnosis, more effective treatments, and a better prognostic outcome.
5 Conclusions
Chronic HCV infection is responsible of a multi-organ, systemic pathological condition whose pathophysiology may include chronic inflammatory-based damage, autoimmune processes, and neoplastic evolution. As a consequence, HCV patients’ clinical picture is not restricted to chronic hepatitis, which presents different severity grades from subclinical inflammation to overt liver cirrhosis. Indeed, several nosographic entities may be associated with chronic HCV infection, ranging from single organ disorders to complex multi-system disorders. The term BHCV syndrome^ was proposed in order to unify all these pathological entities that recognize HCV as the main trigger [1, 2]. As part of HCV syndrome, a few endocrine/ metabolic diseases are nosographically considered, namely AT, type 2 diabetes mellitus, and sexual dysfunction. A subset of each of these diseases may be recognized as HCV-related [1–9].
The fallout of these concepts in everyday clinical practice may be relevant, since it emphasizes the hypothesis of an aetiologic therapy for chronic diseases considered not susceptible of definitive healing, up to date. In particular, the recent introduction of several new antivirals into the physician’s armamentarium has made the hypothesis of a definite treatment more accessible. However, the actual effects of sustained virological response on long term prognosis of HCV-associated autoimmune or neoplastic diseases are not definitely clarified, thus further studies are necessary.
Another important consequence of the identification of HCV syndrome should be the recovery of a holistic vision of the patients with chronic HCV infection, thanks to a multi-disciplinary approach to these patients, leading to a higher probability of early diagnosis, then more effective treatments and a better outcome.
Overall, HCV syndrome remains a useful educational prototype of virus-driven autoimmune and neoproliferative multisystem disorder [1, 2, 77]. The study of HCV syndrome represents one of the most successful research area of translational medicine, in term of aetiopathophysiology understanding and clinical application.
