Association between HCV induced mixed cryoglobulinemia and pulmonary affection: The role of TNF-alpha in the pathogenesis of pulmonary changes

Viral hepatitis and interstitial lung diseases: can HRCT assess their relation and characterize its pattern?

Background

Clinical and pathological studies suggested the presence of a relation between active viral hepatitis and interstitial lung diseases (ILD) ranging from mild to moderate relation. Most studies attribute this relation to viral geno-physiological characteristics. The purpose of the study is first to assess the role of high-resolution computed tomography (HRCT) in evaluating the relation between viral hepatitis and ILDs, then to characterize the predominant pattern of ILD that affects patient management and prognosis.

Results

This prospective study was conducted on 300 patients with viral hepatitis. They were divided into three groups of patients according to blood viremia assessed by polymerase chain reaction (PCR) as well as the diffusing capacity of carbon monoxide (DlCO) in examined pulmonary function tests (PFT). Group [A] included 100 patients with low or moderate viremia and showing normal or low to moderate DlCO decline (> 50%). Group [B] included 100 patients with high viremia and showing normal or low to moderate DlCO decline (> 50%). Group [C] included 100 patients with high viremia and showing a restrictive DlCO decline pattern (< 50%). The study included 182 males and 118 females with a ratio of 3:2, while the age ranged between 40 and 70 years (mean age of 55 years). No ILD was found among the group [A] patient. Meanwhile, 27% of patients in the group [B] showed a non-fibrotic pattern of ILD and 50% of patients in the group [C] showed a fibrotic pattern of ILD. Among patients in group [B] and group [C] together, 77 patients showed ILD accounting for 38.5%.

Conclusion

In concordance with the results of the previous clinicopathological and geno-physiological studies, our HRCT results further established a mild to moderate relation between active hepatitis and ILD regardless of the pulmonary functions. The fibrotic pattern of ILD with poor response to therapy and poor prognosis was found in those patients with concomitant restrictive PFT and rapidly progressive symptoms.

Maternal hepatitis B virus and hepatitis C virus carrier status during pregnancy and long-term respiratory complications in the offspring

OBJECTIVE

Maternal HBV or HCV carrier status is a cause for concern regarding both the course of pregnancy and the short-term perinatal outcomes. Our main aim was to evaluate whether offspring born to carrier mothers during pregnancy, also suffer from long-term pediatric respiratory morbidity (until 18 years of age).

METHOD OF STUDY

A population-based cohort analysis was conducted at a single tertiary medical center. The study included all singleton deliveries between the years 1991-2014, comparing incidence of respiratory-related hospitalization of offspring born to mothers who were carrier of HBV or HCV during their pregnancy to those born to nonexposed mothers. Respiratory morbidities were based on a predefined set of ICD-9 codes. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence between the groups and a Cox regression model was used to adjust for confounding variables.

RESULTS

During the study period, 242,342 deliveries met the inclusion criteria. Of them, 771 (0.31%) were to HBV or HCV mother carriers during pregnancy. A Kaplan-Meier curve demonstrated that children born to HBV or HCV carriers had higher cumulative incidence of respiratory morbidity (Log rank test p = 0.007). In the Cox regression model, while controlling for maternal age, diabetes mellitus, hypertensive disorders, caesarian section and gestational age at birth, maternal HBV or HCV carrier status was noted as an independent risk factor for long-term respiratory morbidity in the offspring (adjusted HR = 1.43, 95% CI 1.07-1.90, p = 0.015).

CONCLUSIONS

Maternal HBV or HCV carrier status in pregnancy may increase offspring susceptibility to long-term respiratory morbidity.

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.