The practically constant cure of patients infected with the hepatitis C virus (HCV) has led to HCV elimination policies (1), which are all the more justified as they reduce the hepatic and extra-hepatic morbidity and mortality due to hepatotropism, lymphotropism and chronic inflammation of HCV infection (2).
Studies have shown paradoxical excessive hepatic morbidity and mortality in patients cured of HCV, who have left medical supervision (3). This is mainly due to hepatic comorbidities (excessive alcohol consumption, excess body weight with metabolic syndrome and HIV or HBV coinfections) which, despite the virological cure, inhibit liver disease repair and, in particular, the remodeling of the fibrosis. They run the risk of transforming an initial viral liver disease into a metabolic or toxic liver disease. A high body mass index or diabetes therefore reduces the hope of reversing the HBV cirrhosis: in a prospective study including histological controls at the beginning of treatment, after 1 and 5 years of Tenofovir treatment, these comorbidities reduced the chance of cirrhosis reversibility by 70% whereas 96% of the patients had an inactivation of their necrotico-inflammatory disease (4).
Alcohol also has a major impact by limiting hepatic repair and promoting the development of alcoholic liver disease on pre-existing viral fibrosis. This burden of high alcohol consumption has been clearly demonstrated in France, British Columbia, Australia and Scotland (5, 6). Excessive alcohol consumption is associated with an increased risk of liver transplantation or death in patients with chronic hepatitis C virus infection.
Hepatic comorbidities largely contribute to the burden of viral hepatitis C in France (5). This justifies the provision of multidisciplinary management, in parallel with the policy of eliminating HCV by improving screening, access to treatment and follow-up, in order to obtain behavioral changes with alcohol withdrawal, a healthy hygiene and dietary lifestyle, weight and other viral diseases control with improved monitoring. The benefit of these integrated policies for HIV has been clearly demonstrated by a significant reduction in morbidity and mortality.
Professor Stanislas Pol