Alteraciones del metabolismo lipídico producidas por el virus de la hepatitis c en pacientes con infección crónica

• Ainara Muñoz Cabrejas ^[1] ; Silvia Espina ; José Miguel Arbones Mainar ; Belén Moreno Franco
  1. [1] Adipocyte and Fat Biology Laboratory (AdipoFat). Unidad de Investigación Traslacional. Hospital Universitario Miguel Servet. Instituto Aragonés de Ciencias de la Salud (IACS). Instituto de Investigación Sanitaria de Aragón (IIS Aragón). Zaragoza. España.
• Localización: Revista española de salud pública, ISSN 1135-5727, ISSN-e 2173-9110, Nº. 94, 2020
• Idioma: español
• Títulos paralelos:
  • Lipid metabolism alterations produced by hepatitis C virus in patients with chronic infection
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    Fundamentos: Es conocido que la infección crónica por el virus de la hepatitis C (VHC) genera un perfil lipídico aparentemente favorable. Paradójicamente, estos pacientes presentan un aumento de eventos cardiovasculares concomitantes. Los objetivos de la presente revisión fueron analizar y sintetizar los estudios que indagasen en las modificaciones que produce el VHC sobre el metabolismo lipídico de los pacientes con infección crónica, así como estudiar si esas modificaciones pueden asociarse a episodios posteriores de enfermedad cardiovascular.

    Métodos: Se realizó una búsqueda bibliográfica en las bases de datos de Medline y Scopus de los artículos publicados desde enero de 2008 hasta febrero de 2019. Se identificaron un total de 901 publicaciones, de las cuales se revisaron 10 estudios que cumplieron con los criterios de inclusión y exclusión propuestos.

    Resultados: Se encontró que en los pacientes con infección crónica por el VHC estaban disminuidos los niveles de colesterol total y sus fracciones lipídicas. No existió una clara asociación con los niveles de triglicéridos. Además, parecía haber una asociación entre la infección crónica por VHC y un aumento del riesgo de padecer aterosclerosis y de desarrollar enfermedades cardiovasculares.

    Conclusiones: La infección crónica por el VHC tiene un efecto hipolipemiante y aumenta el riesgo cardiovascular.

    Se precisan estudios prospectivos que analicen el efecto de las nuevas terapias con antivirales de acción directa sobre el metabolismo lipídico y el riesgo cardiovascular.

  • English

    Background: Chronic infection with the hepatitis C virus (HCV) is known to generate an apparently favorable lipid profile. Paradoxically, these patients present an increase in concomitant cardiovascular events. The objectives of the present review were to analyze and synthesize studies that inquired into the changes produced by hepatitis C virus (HCV) in the lipid metabolism of patients with chronic infection, and about whether these modifications can be associated with subsequent episodes of cardiovascular diseases.

    Methods: A bibliographic search was carried out in the Medline and Scopus databases of the articles published from January 2008 to February 2019. A total of 901 publications were identified, of which 10 studies that fulfilled the inclusion and exclusion criteria were reviewed.

    Results: It was found that the levels of total cholesterol and its lipid fractions were decreased in patients with chronic HCV infection. There was no clear association with triglyceride levels. In addition, there seemed to be an association between chronic HCV infection and an increased risk of developing atherosclerosis and cardiovascular diseases.

    Conclusions: Chronic HCV infection has a lipid- lowering effect and increases cardiovascular risk.

    Prospective studies are needed to analyze the effect of new therapies with direct-acting antivirals on lipid metabolism and cardiovascular risk.

• Referencias bibliográficas
  • Bruggmann P, Berg T, Øvrehus ALH et al. Historical epidemiology of hepatitis C virus (HCV) in selected countries. J Viral Hepat. 2014;21:5–33.
  • World Health Organization. Global hepatitis report, 2017 [Internet]. WHO. 2017 [consultado el 01/11/2018]. p. 62. Disponible en: http://www.who.int/hepatitis.
  • Gobierno de España. 117.452 pacientes han recibido en España tratamiento de última generación para la Hepatitis C [Internet]. La Moncloa.gob.es....
  • WHO. Guidelines for the screening, care and treatment of persons with hepatitis C infection [Internet]. Ginebra: World health Organization....
  • Martínez-Rebollar M, Larrousse M, Calvo M et al. Estado actual de la hepatitis aguda C. Enferm Infecc Microbiol Clin. 2011;29(3):210–5.
  • WHO. Hepatitis C: Key facts [Internet]. Ginebra: World health Organization. 2017 [consultado el 05/05/2018]. p.9. Disponible en: http://www.who.int/en/news-room/factsheets/detail/hepatitis-c.
  • Centers for Disease Control and Prevention. Hepatitis C FAQs for Health Professionals [Internet]. CDC. 2018 [consultado el 04/25/2018]. p....
  • Serfaty L. Metabolic Manifestations of Hepatitis C Virus: Diabetes Mellitus, Dyslipidemia. Clin Liver Dis. 2017;21(3):475–86.
  • Honda A, Matsuzaki Y. Cholesterol and chronic hepatitis C virus infection. Hepatol Res. 2011;41(8):697–710.
  • Marzouk D, Sass J, Bakr I et al. Metabolic and cardiovascular risk profiles and hepatitis C virus infection in rural Egypt. Gut. 2007;56(8):1105–10.
  • Hsu C-S, Liu C-J, Liu C-H et al. Metabolic profiles in patients with chronic hepatitis C: a case-control study. Hepatol Int. 2008;2(2):250–7.
  • Butt AA, Xiaoqiang W, Budoff M et al. Hepatitis C Virus Infection and the Risk of Coronary Disease. Clin Infect Dis. 2009;49(2):225–32.
  • Corey KE, Kane E, Munroe C et al. Hepatitis C virus infection and its clearance alter circulating lipids: Implications for long-term follow-up....
  • Siagris D, Christofidou M, Theocharis GJ et al. Serum lipid pattern in chronic hepatitis C: histological and virological correlations. J Viral...
  • Miyazaki T, Honda A, Ikegami T et al. Hepatitis C virus infection causes hypolipidemia regardless of hepatic damage or nutritional state:...
  • Chang M-L. Metabolic alterations and hepatitis C: From bench to bedside. World J Gastroenterol. 2016;22(4):1461–77.
  • Aizawa Y, Seki N, Nagano T et al. Chronic hepatitis C virus infection and lipoprotein metabolism. World J Gastroenterol. 2015;21(36):10299–313.
  • Gershon AS, Margulies M, Gorczynski RM et al. Serum cytokine values and fatigue in chronic hepatitis C infection. J Viral Hepat. 2000;7(6):397–402.
  • Hansson GK. Inflammation, Atherosclerosis, and Coronary Artery Disease. N Engl J Med. 2005;352(16):1685–95.
  • Hansson GK, Libby P. The immune response in atherosclerosis: a double-edged sword. Nat Rev Immunol. 2006;6(7):508–19.
  • Libby P. Inflammation in atherosclerosis. Nature. 2002;420(6917):868–74.
  • Mehta SH, Brancati FL, Sulkowski MS et al. Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United...
  • Mehta S, Brancati FL, Strathdee SA et al. Hepatitis C virus infection and incident type 2 diabetes. Hepatology. 2003;38(1):50–6.
  • Butt AA, Fultz SL, Kwoh CK et al. Risk of diabetes in HIV infected veterans preand post-HAART and the role of HCV coinfection. Hepatology....
  • Shaheen M, Echeverry D, Oblad MG et al. Hepatitis C, metabolic syndrome, and inflammatory markers: results from the Third National Health...
  • Koike K. Hepatitis C as a metabolic disease: Implication for the pathogenesis of NASH. Hepatol Res. 2005;33(2):145–50.
  • Forde KA, Haynes K, Troxel AB et al. Risk of myocardial infarction associated with chronic hepatitis C virus infection: a population-based...
  • Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Internet]. The Cochrane Collaboration;...
  • Moher D, Liberati A, Tetzlaff J et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med...
  • Scottish Intercollegiate Guidelines Network. Sign Grading System 1999 – 2012 [Internet]. Edimburgo: SIGN. 2012 [consultado el 06/20/2018]....
  • Marzo-Castillejo M, Viana-Zulaica C. Calidad de la evidencia y grado de recomendación. Guias Clílnicas. 2007;7(1:6):1–14.
  • Petta S, Maida M, Macaluso FS et al. Hepatitis C Virus Infection Is Associated with Increased Cardiovascular Mortality: A Meta-Analysis of...
  • Olubamwo OO, Onyeka IN, Miettola J, et al. Hepatitis C as a risk factor for carotid atherosclerosis a systematic review. Clin Physiol Funct...
  • Olubamwo OO, Aregbesola AO, Miettola J et al. Hepatitis C and risk of coronary atherosclerosis – A systematic review. Public Health. 2016;138:12–25.
  • Pateria P, Jeffrey GP, Macquillan G et al. The association between chronic hepatitis C infection and cardiovascular risk. Intern Med J. 2016;46(1):63–70.
  • Butt AA, Yan P, Simon TG et al. Changes in circulating lipids level over time after acquiring HCV infection: Results from ERCHIVES. BMC Infect...
  • Butt AA, Yan P, Chew KW et al. Risk of Acute Myocardial Infarction among Hepatitis C Virus (HCV)-Positive and HCV-Negative Men at Various...
  • Ramcharran D, Wahed AS, Conjeevaram HS et al. Serum lipids and their associations with viral levels and liver disease severity in a treatment-naïve...
  • Miyajima I, Kawaguchi T, Fukami A et al. Chronic HCV infection was associated with severe insulin resistance and mild atherosclerosis: A population-based...
  • Kakinami L, Block RC, Adams MJ et al. Risk of cardiovascular disease in HIV, Hepatitis C, or HIV/Hepatitis C patients compared to the general...
  • Roed T, Kristoffersen US, Knudsen A et al. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis...
  • Cicognani C, Malavolti M, Morselli-Labate AM et al. Serum lipid and lipoprotein patterns in patients with liver cirrhosis and chronic active...
  • Wang C, Kao J. Hepatitis C virus infection, lipids, and coronary heart disease: a Pandora’s box. Hepatology. 2010;51:343.
  • Maggi G, Bottelli R, Gola D et al. Serum cholesterol and chronic hepatitis C. Ital J Gastroenterol. 28(8):436–40.
  • Serfaty L, Andreani T, Giral P et al. Hepatitis C virus induced hypobetalipoproteinemia : a possible mechanism for steatosis in chronic hepatitis...
  • Moriya K, Shintani Y, Fujie H et al. Serum lipid profile of patients with genotype 1b hepatitis C viral infection in Japan. Hepatol Res. 2003;25(4):371—6.
  • Babiker A, Jeudy J, Kligerman S et al. Risk of Cardiovascular Disease Due to Chronic Hepatitis C Infection: A Review. J Clin Transl Hepatol....
  • Shah P. Link between infection and atherosclerosis: who are the culprits: viruses, bacteria, both, or neither? Circulation. 2001;103:5–6.
  • Zampino R, Marrone A, Restivo L et al. Chronic HCV infection and inflammation: Clinical impact on hepatic and extrahepatic manifestations....
  • Leandro G, Mangia A, Hui J et al. Relationship Between Steatosis, Inflammation, and Fibrosis in Chronic Hepatitis C: A Meta-Analysis of Individual...
  • Alyan O, Kacmaz F, Ozdemir O et al. Hepatitis C infection is associated with increased coronary artery atherosclerosis defined by modified...
  • Tsui JI, Whooley MA, Monto A et al. Association of Hepatitis C Virus Seropositivity With Inflammatory Markers and Heart Failure in Persons...
  • Riordan SM, Skinner NA, Kurtovic J et al. Toll-like receptor expression in chronic hepatitis C: Correlation with pro-inflammatory cytokine...
  • Oliveira CPMS, Kappel CR, Siqueira ER et al. Effects of Hepatitis C virus on cardiovascular risk in infected patients: A comparative study....
  • Negro F. Facts and fictions of HCV and comorbidities: Steatosis, diabetes mellitus, and cardiovascular diseases. J Hepatol. 2014;61(1):69–78.
  • Adinolfi LE, Restivo L, Zampino R et al. Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCVrelated steatosis. Atherosclerosis....
  • Petta S, Torres D, Fazio G et al. Carotid atherosclerosis and chronic hepatitis C: A prospective study of risk associations. Hepatology. 2012;55(5):1317–23.