Detection of HCV-RNA in bronchoalveolar lavage from a woman with pulmonary fibrosis

HCV Extrahepatic Manifestations

Hepatitis C virus (HCV) has been shown to affect many tissues other than liver. However, of the many extrahepatic manifestations (EMs) that have been associated with HCV, including cryoglobulinemia, lymphoma, insulin resistance, type 2 diabetes and neurological disorders, only a few have been shown to be directly related to HCV infection of extrahepatic tissues. HCV-triggered immune-mediated mechanisms account for most of the EMs. It is estimated that up to 74% of patients with chronic hepatitis C can develop at least one EM. All HCV patients with EMs should be considered for antiviral therapy, although not all will resolve with sustained virological response.

Hepatitis C Virus-Associated Extrahepatic Manifestations in Lung and Heart and Antiviral Therapy-Related Cardiopulmonary Toxicity

Besides liver cirrhosis and hepatocellular carcinoma, chronic hepatitis C virus (HCV) infection is associated with many extrahepatic manifestations (EHMs). HCV exhibits lymphotropism that is responsible for various EHM. An important characteristic of HCV is escape from the immune system, which enables it to produce chronic infections and autoimmune disorders along with accumulation of circulating immune complexes. These EHMs have large spectrum, because they affect many organs such as heart, lungs, kidney, brain, thyroid, and skin. HCV-related cardiac and pulmonary manifestations include myocarditis, cardiomyopathies, cardiovascular diseases (i.e., Stroke, ischemic heart disease), chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, asthma, and interstitial lung diseases. This review discusses etiology and pathogenesis of HCV-associated cardiac and pulmonary manifestations and how different genes, immune system, indirectly linked factors (mixed cryoglobulinemia), liver cirrhosis, and antiviral treatment are involved in HCV-related heart and lung diseases, however, their exact mechanism is not clear.

Pulmonary alterations in patients with chronic HCV infection

BACKGROUND

Chronic hepatitis C virus infection has been reported in association with several extrahepatic manifestations. Included in this list is interstitial lung involvement.

AIMS

The aim of the present study was to evaluate pulmonary alterations in patients with chronic hepatitis C virus infection.

PATIENTS

Twenty-one patients with chronic hepatitis C virus infection were enrolled into a prospective study. One patient has been excluded because of underlying tuberculosis.

METHODS

All patients underwent pulmonary function tests, diffusion capacity for carbon monoxide and high-resolution computed tomography of the chest.

RESULTS

Forced vital capacity, forced expiratory volume in first second/forced vital capacity and forced expiratory volume in first second values were reduced to less than 80% of predicted values in 3, 11 and 5 patients, respectively. Diffusion capacity for carbon monoxide was low in 12 patients (60%), 8 of whom had simultaneous decrease in diffusion capacity for carbon monoxide/VA values. Thorax high-resolution computed tomography revealed abnormal findings in eight patients (40%). Fifteen patients with chronic hepatitis C virus infection (75%) had at least one pulmonary alteration as evidenced by abnormal pulmonary function tests, diffusion capacity for carbon monoxide and/or high-resolution computed tomography results.

CONCLUSION

In spite of a limited study population, these findings may implicate that pulmonary manifestations of chronic hepatitis C virus infection are frequently underdiagnosed.

Hepatitis C virus and the lung: implications for therapy

Hepatitis C virus (HCV) infection is a chronic blood-borne disease that affects > 4,000,000 individuals in the United States. The majority of individuals with HVC infection acquire a chronic hepatitis that predisposes them to the complications of cirrhosis and hepatoma. Chronic HCV infection is, however, associated with multiple extrahepatic manifestations as well, including recently recognized effects on the lung. These include primary effects on lung function, as well as secondary effects in the settings of progressive liver disease and drug treatment for HCV. In this article, we discuss the emerging clinical data that support a role for HCV infection in lung disease, describe the multiple pulmonary manifestations of this viral infection, and outline the therapies available for specific pulmonary complications of chronic HCV infection.