Extrahepatic disease in a cohort of HCV infected patients succesfully treated with direct acting antivirals. One year follow up.

Introduction and Objectives

The hepatitis C virus (HCV) infects hepatocytes and B lymphocytes. The ability to infect B lymphocytes has been linked to cryoglobulinemia, cryoglobulinemia syndrome, lymphomas, and organ-specific and systemic autoimmune diseases (AD). Among the AD, diabetes mellitus, thyroiditis, and Sjögren syndrome stand out as extrahepatic diseases (EH). The aim of a study was identify HCV-related EH, during infection and one year after successfully direct-acting antiviral (DAA) treatment

Materials and Patients

We conducted a prospective study in a Regional Hospital of reference for the treatment of Hepatitis C, from 14 hospital units in the Northeast of Mexico. From June 15, 2018, to January 1, 2023.

Results

Of 364 patients with positive serology, 153 had viremia, and 127 received DAA, with different schemes aligned to the guidelines of treatment of hepatitis C. 50% were women, with a mean age of 54. 80% received regimens based on sofosbuvir. 96.8% achieved a sustained viral response 12. Before the treatment with DAA, we identified nine hypothyroidisms, eight cryoglobulinemic vasculitis, one with anemia and thrombocytopenia autoimmune, and 25 with diabetes. At basal visit for treatment, 17 hypothyroidisms, eight prediabetes, eight diabetes, one lymphoma, one monoclonal gammopathy of uncertain significance, three rheumatoid arthritis, and three hepatocellular carcinomas. At one year of follow-up, plus sixteen with diabetes mellitus, three with hepatocarcinoma, 6 with xerophthalmia, and one with breast cancer, increasing obesity, and fatty liver were identified.

Conclusions

EH is frequent and carries out morbidity, especially proliferative disorders of B lymphocytes and AD as some can persist even after the treatment of HCV infection. The intentional search for EH should be mandatory and, once identified, will be multidisciplinary follow-up, for the timely identification of worsening or malignant transformation, to offer timely diagnosis and treatment.

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors