Hepatitis C Updates: Fatigue, Parkinson's and Heart Disease

What Role Does HCV Have in Fatigue, Parkinson's and Cardiovascular Disease?

Electron micrograph of hepatitis C virion (HCV). Photo Credit: BSIP/UIG/Getty Images

As the treatment of hepatitis C has rapidly evolved in recent years, the medical literature regarding various aspects of the disease has also been evolving.  Importantly, we are realizing that the hepatitis C virus is capable of causing much more than just liver disease.  In this update, I have selected three recent publications which point out associations of hepatitis C infection and cardiovascular disease, Parkinson’s disease, and fatigue (http://hepatitis.about.com/od/symptoms/a/symptoms.htm).

Hepatitis C virus infection is associated with increased cardiovascular mortality.

Investigators in Italy recently performed an analysis of published reports on the association of hepatitis C and various cardiovascular events including deaths.  This study was recently published in Gastroenterology (2016;150:145-155)(LINK). The findings of this well-done investigation reveal that those with hepatitis C have a 1.65-fold increase in cardiovascular mortality, a 2.27-fold increase in carotid artery plaques, and a 1.30-fold increase in stroke events compared to those who did not have hepatitis C.  Importantly, they found that this increased risk was greater in those who had diabetes or hypertension or who were smokers. Why should this be happening?  We now realize that hepatitis C disease is not limited to just liver disease. It has been associated with development of type-2 diabetes, insulin resistance, and fatty liver in some patients.

This suggests that hepatitis C is able to induce changes in lipid metabolism which could predispose to cardiovascular events.  The take home message would seem to be that patients with long-standing hepatitis C should be assessed and counseled for cardiovascular disease by their physicians.  There is some emerging evidence that eradication and cure of hepatitis C infection lowers the risk of death from all disorders, not just liver disease.

Hepatitis C Virus Infection: A Risk Factor for Parkinson's Disease

In a large population-based study from Taiwan, involving 61,363 subjects, there was a statistically significant association between having hepatitis C and Parkinson’s disease (a 1.39-fold risk) which was not seen with hepatitis B infection (J. Viral Hepatitis  ). The true significance of this association is still unclear since association does not necessarily imply causation. Nonetheless, it was a large population based analysis.  It will need to be confirmed in other populations and the CDC-based NHANES study in the USA might be a good place to look.

Effects of viral eradication with Ledipasvir and Sofosbuvir, with or without ribavirin, on measures of fatigue in patients with chronic hepatitis C virus infection.

Fatigue is a common symptom of hepatitis C infection and may have many causes. It may be “peripheral fatigue” associated with loss of muscle strength, or “central fatigue” which is not explained by loss of muscle strength. Those with central fatigue may have sleep disturbances as well as abnormalities in mood and behavior. In this investigation (LINK), 100 hepatitis C patients were assessed before and after treatment and eradication (cure) of their hepatitis infection.

By as soon as 4 weeks after the end of successful treatment, all fatigue-associated symptoms improved significantly. This improvement was associated with improved levels of several body chemicals that were statistically associated with levels of fatigue at baseline.  Although the finding that fatigue improves with successful therapy is not new, this study demonstrated that there are specific metabolic pathways somehow imbalanced by the virus that were corrected when the virus was eradicated. So it’s not all in your head after all…..or was it?

These recent studies are important additions to our understanding of hepatitis C and should be part of any discussion with your physician.

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