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World J Gastroenterol. Jun 14, 2022; 28(22): 2429-2436
Published online Jun 14, 2022. doi: 10.3748/wjg.v28.i22.2429
Metabolic aspects of hepatitis C virus
Mohamed El-Kassas, Abeer Awad
Mohamed El-Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Abeer Awad, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11566, Egypt
Author contributions: El-Kassas M conceptualized the idea, revised and edited the final manuscript; Awad A drafted the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mohamed El-Kassas, MD, Full Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan, Cairo 11795, Egypt.
Received: January 6, 2022
Peer-review started: January 6, 2022
First decision: March 9, 2022
Revised: March 18, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: June 14, 2022

Many metabolic factors are associated with chronic hepatitis C virus (HCV) infection and can influence the course of the illness and impact the progression of liver and non-liver-related diseases through complex interactions. Several of these factors impact the course of chronic HCV (CHC) and result in the conceptual translation of CHC from a localized to systemic disease. Besides the traditional liver manifestations associated with CHC infection, such as cirrhosis and hepatocellular carcinoma, various extrahepatic disorders are associated with HCV infection, including atherosclerosis, glucose and lipid metabolic disturbances, alterations in the iron metabolic pathways, and lymphoproliferative diseases. The coexistence of metabolic disorders and CHC is known to influence the chronicity and virulence of HCV and accelerates the progression to liver fibrosis and hepatocellular carcinoma. Insulin resistance is one of the key factors that have a tremendous metabolic impact on CHC. Therefore, there is a great need to properly evaluate patients with CHC infection and correct the modifiable metabolic risk factors. Furthermore, patients with HCV who achieved a sustained virological response showed an overall improvement in glucose metabolism, but the exact evidence still requires further studies with long-term follow-up. This review delineates the most recent evidence on the main metabolic factors associated with CHC and the possible influence of chronic HCV infection on metabolic features.

Keywords: Hepatitis C virus, Metabolic factors, Steatosis, Insulin resistance

Core Tip: Hepatitis C virus (HCV) infection has several metabolic aspects that are largely well understood; as such, HCV is nowadays considered a systemic disease rather than a local disease with different metabolic consequences. Moreover, these metabolic factors may affect the natural history of chronic liver disease and of diseases not related to the liver, which constitute a significant burden on the overall health of the human body, with an increased economic burden to patients, healthcare systems, and society if not adequately addressed and appropriately managed. More studies are needed to evaluate metabolic aspects associated with HCV infection and delineate their effects and the long-term outcome of antiviral therapies.