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• W1756530559 abstract "Although the causality of hepatitis C virus in stroke is not conclusive, some clinical studies have shown an increased risk of stroke in patients with chronic hepatitis C. In their Review, Jennifer Fugate and colleagues1Fugate JE Lyons JL Thakur KT Smith BR Hedley-Whyte ET Mateen FJ Infectious causes of stroke.Lancet Infect Dis. 2014; 14: 869-880Summary Full Text Full Text PDF PubMed Scopus (94) Google Scholar propose several interesting hypotheses to explain the link between chronic infection and stroke that might also be applied to the association of hepatitis C virus infection with stroke. Accumulating evidence shows the metabolic manifestations of hepatitis C virus, and provides a strong link between hepatitis C virus clearance and a decrease in the risk of stroke. Chronic hepatitis C virus infection not only results in an overall inflammatory state, but clinical evidence also shows statistically significant associations between hepatitis C virus and metabolic derangements2Hsu CS Kao JH Hepatitis C virus and lipid profiles: more questions than answers?.Hepatol Int. 2011; 29: 865-867Crossref Scopus (2) Google Scholar that might contribute to atherosclerosis. Additionally, based on data from cell and small animal models, chronic hepatitis C virus infection might induce several complex mechanisms that lead to inflammation, metabolic derangements, steatosis, insulin resistance, fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, hepatitis C virus has been hypothesised to interact extensively with host metabolic factors to establish productive infection and trigger unique pathological processes.3Li Q Pene V Krishnamurthy S Cha H Liang TJ Hepatitis C virus infection activates an innate pathway involving IKK-alpha in lipogenesis and viral assembly.Nature Med. 2013; 19: 722-729Crossref PubMed Scopus (155) Google Scholar Several studies have investigated the effect of manipulating the metabolic derangement, including insulin resistance and dyslipidaemia, on patients with chronic hepatitis C when they receive pegylated interferon-based treatment.4Romero-Gomez M Diago M Andrade RJ et al.Treatment of insulin resistance with metformin in naive genotype 1 chronic hepatitis C patients receiving peginterferon alfa-2a plus ribavirin.Hepatology. 2009; 50: 1702-1708Crossref PubMed Scopus (136) Google Scholar The studies found that adding insulin sensitisers or lipid-lowering agents to pegylated interferon-based therapy might substantially improve the efficacy of pegylated interferon-based treatment in patients with chronic hepatitis C. Moreover, in a 5-year Taiwan nationwide cohort study that included 3113 patients with hepatitis C virus and 12 452 uninfected participants matched for age and sex, interferon-based therapy reduced the risk of stroke by 61% in patients with hepatitis C virus infection after adjusting for known prognostic factors.5Hsu CS Kao JH Chao YC et al.Interferon-based therapy reduces risk of stroke in chronic hepatitis C patients: a population-based cohort study in Taiwan.Alimentary Pharmacol Ther. 2013; 38: 415-423Crossref PubMed Scopus (99) Google Scholar Although evidence has not proven a causality for hepatitis C virus infection in stroke, consideration of the temporality, specificity, consistency, and strength of evidence supporting the association, clinical awareness of stroke in the management of patients with hepatitis C virus, and vice versa, is warranted. I declare no competing interests. This work was supported by grants from the Taipei Tzu Chi Hospital, the Department of Heath, and the National Science Council, Executive Yuan, Taiwan (NSC99-2314-B-303-004, TCRD-TPE-99-09, TCRD-TPE-100-C1-2, TCRD-TPE-101-17, and TCRD-TPE-103-35). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Infectious causes of strokeMost infectious pathogens have anecdotal evidence to support a link with stroke, but certain pathogens have more robust associations, in which causation is probable. Few dedicated prospective studies of stroke in the setting of infection have been done. The use of head imaging, a clinical standard of diagnostic care, to confirm stroke and stroke type is not universal. Data for stroke are scarce in locations where infections are probably most common, making it difficult to reach conclusions on how populations differ in terms of risk of infectious stroke. Full-Text PDF" @default.
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• W1756530559 date "2015-06-01" @default.
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• W1756530559 title "Infectious causes of stroke" @default.
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