Hepatitis C Virus (HCV) Infection: Pathogenesis, Oral Manifestations, and the Role of Direct-Acting Antiviral Therapy: A Narrative Review
Abstract
:1. Introduction
1.1. Pathophysiology
1.1.1. Viral Entry and Replication
1.1.2. Immune Response and Liver Damage
1.1.3. Chronic Infection and Fibrosis
1.1.4. Extrahepatic Manifestations
2. Oral Manifestations
2.1. OLP
- Th1 cytokines and immune response: El-Howati et al. emphasize the role of CD8+ cytotoxic and CD4+ Th1 polarized T-cells in OLP, noting the involvement of other Th subsets such as Th9, Th17, and Tregs in the disease’s pathogenesis. They suggest that both direct effects of HCV on the immune system and broader dysregulation contribute to OLP [40]. Studies have consistently shown an increased production of Th1 cytokines, including TNF-alpha, which indicates a strong Th1-mediated immune response [39].
- Role of CD8+ cytotoxic T-cells: CD8+ T-cells are crucial for targeting HCV-infected cells. However, the high mutation rate of HCV often leads to immune escape, resulting in chronic infection. This mechanism is well-documented and highlights the challenges in clearing the virus [41].
- Helper T-cells and sustained Th1 response: Helper T-cells assist in maintaining the function of CD8+ T-cells and in cytokine production. In chronic HCV infection, this leads to a sustained Th1 response, which can become dysregulated over time. This prolonged response contributes to the pathology observed in OLP [42].
- Th9, Th17, and regulatory T-cells (Tregs): Th9 and Th17 cells are associated with inflammation and tissue damage, which are characteristic of chronic infections. Studies have shown that these cells contribute to the immunopathogenesis of OLP [42]. Tregs help maintain immune tolerance and prevent autoimmune responses. Their altered function during HCV infection is a significant factor in the disease progression [42].
- Salivary cytokine profiles in OLP patients: Research on salivary cytokine profiles in OLP patients has found higher concentrations of IL-2, IL-23, and TGF-β, suggesting these cytokines play a role in OLP pathogenesis [43]. Askoura et al. reported elevated levels of IL-33, IL-17, and IL-25 in HCV patients, indicating their involvement in inflammation and the progression of fibrosis [44].
- Cytokines and disease prognosis: Zhu et al. highlighted a set of cytokines/chemokines correlated with disease prognosis in chronic liver disease, which is relevant for understanding OLP associated with HCV [45]. Vičić et al. reviewed the immunopathogenesis of lichen planus, emphasizing the complex interplay of immune cells and inflammatory pathways in HCV-associated OLP [46].
- Impact of HCV eradication on cytokine profiles: Radmanić et al. evaluated the impact of HCV eradication on cytokine and growth factor profiles, providing insights into potential changes in the cytokine environment in OLP following HCV treatment [47].
2.2. Xerostomia and Sjögren’s Syndrome-like Manifestations
2.3. Periodontal Disease
2.4. Head and Neck Squamous Cell Carcinoma
3. Materials and Methods
3.1. Search Strategy
3.2. Selection Criteria
3.3. Data Collection
3.4. Analysis Method
3.5. Ethical Considerations
4. Conclusions
Funding
Conflicts of Interest
References
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Di Stasio, D.; Guida, A.; Romano, A.; Petruzzi, M.; Marrone, A.; Fiori, F.; Lucchese, A. Hepatitis C Virus (HCV) Infection: Pathogenesis, Oral Manifestations, and the Role of Direct-Acting Antiviral Therapy: A Narrative Review. J. Clin. Med. 2024, 13, 4012. https://doi.org/10.3390/jcm13144012
Di Stasio D, Guida A, Romano A, Petruzzi M, Marrone A, Fiori F, Lucchese A. Hepatitis C Virus (HCV) Infection: Pathogenesis, Oral Manifestations, and the Role of Direct-Acting Antiviral Therapy: A Narrative Review. Journal of Clinical Medicine. 2024; 13(14):4012. https://doi.org/10.3390/jcm13144012
Chicago/Turabian StyleDi Stasio, Dario, Agostino Guida, Antonio Romano, Massimo Petruzzi, Aldo Marrone, Fausto Fiori, and Alberta Lucchese. 2024. "Hepatitis C Virus (HCV) Infection: Pathogenesis, Oral Manifestations, and the Role of Direct-Acting Antiviral Therapy: A Narrative Review" Journal of Clinical Medicine 13, no. 14: 4012. https://doi.org/10.3390/jcm13144012