Background and aims Extrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferon-free antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating non-cirrhotic chronically infected individuals.
Methods A systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.
Results Data were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses.
Conclusion Antiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies.
- hepatitis C
- extrahepatic manifestations
- antiviral therapy
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Contributors Concept and design: PC, ACD, CC, DS. Procedures: PC, ACD, CC, DS. Writing of article: PC, DS.
Funding This work was supported by WHO and UNITAID. Main results were presented at the WHO meeting of the Guidelines Development Group for the Hepatitis C Treatment (Geneva, Switzerland, September 2017). It was also supported by an unrestricted grant from Gilead.
Competing interests PC has received consulting and lecturing fees from Abbvie, Astra Zeneca, Bristol-Myers Squibb, Gilead, Glaxo Smith Kline, Janssen, Merck Sharp Dohme, Roche, Servier and Vifor. PC has received grants from CNRS, INSERM, Université Pierre et Marie Curie, ANRS and WHO. DS has received consulting and lecturing fees from Medimmune, Abbvie, Bristol Meyer Squibb, Roche, Servier, Gilead, AstraZeneca and GlaxoSmithKline.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.