Direct-acting antivirals used in HCV-related liver disease do not affect thyroid function and autoimmunity

Abstract

Purpose It is well known that interferon-α (IFN-α), used for long time as the main therapy for HCV-related disease, induces thyroid alterations, but the impact of the new direct-acting antivirals (DAAs) on thyroid is not established. Aim of this prospective study was to evaluate if DAAs therapy may induce thyroid alterations. Methods A total of 113 HCV patients, subdivided at the time of the enrollment in naïve group (n = 64) and in IFN-α group (n = 49) previously treated with pegylated interferon-α and ribavirin, were evaluated for thyroid function and autoimmunity before and after 20–32 weeks of DAAs. Results Before starting DAAs, a total of 8/113 (7.1%) patients showed Hashimoto's thyroiditis (HT) all belonging to IFN-α group (8/49, 16.3%), while no HT cases were found in the naïve group. Overall, 7/113 (6.2%) patients were hypothyroid: 3/64 (4.7%) belonging to naïve group and 4/49 (8.2%) to IFN-α group. Furthermore, a total of 8/113 patients (7.1%) showed subclinical hyperthyroidism: 2/64 (3.1%) were from naïve group and 6/49 (12.2%) from IFN-α group. Interestingly, after DAAs therapy, no new cases of HT, hypothyroidism and hyperthyroidism was found in all series, while 6/11 (54.5%) patients with non-autoimmune subclinical thyroid dysfunction became euthyroid. Finally, the only association between viral genotypes and thyroid alterations was genotype 1 and hypothyroidism. Conclusions This study supports evidence that DAAs have a limited or missing influence on thyroid in patients with HCV-related diseases. Moreover, it provides preliminary evidence that subclinical non-autoimmune thyroid dysfunction may improve after HCV infection resolution obtained by DAAs.

Study of thyroid hormones effect on biochemical parameters of liver function in Iraqi patients

“…In a similar fashion, patients with acute or chronic liver disease may have changes in thyroid function tests which improve as the liver inflammation resolves. These interrelationships must be remembered if errors in patient care are to be avoided [16][17][18]. This study is agreed with our study.…”

Viruses and Endocrine Diseases

“…Unfortunately, there are few clinical data in this regard. The recent direct-acting antivirals used in chronic HCV infection treatment have been shown to reduce not only liver-related mortality but also morbidity due to extra-hepatic manifestations, including several endocrine disorders [ 121 , 122 , 177 ]. A decrease in HIV-associated endocrinopathies since the widespread use of antiretroviral therapies has been reported [ 2 , 3 ].…”

“…The development of T1D and hypopituitarism seem rare and doubtful in patients infected with HCV receiving IFN-α therapy [ 119 , 120 ]. However, current protocols tend to use direct-acting antivirals in HCV-related diseases, which have been shown not to affect thyroid function or to trigger autoimmunity [ 121 , 122 ].…”