Effect of treatment with direct acting antivirals on body mass index and hepatic steatosis in chronic hepatitis C

Abstract

Direct Acting Agents (DAAs) have high cure rate but still lack the knowledge of their effect on hepatic steatosis in chronic hepatitis C (CHC). Controlled Attenuation Parameter (CAP), evaluated with transient elastography, could help in assessment of steatosis grades. We aim to evaluate the effect of DAAs on BMI and steatosis in CHC using CAP. This cohort study included 155 CHC Egyptian patients divided into three groups according to the DAAs regimens. All patients were subjected to pre-treatment and 3-months post-treatment evaluation including BMI, laboratory workup and liver stiffness measurement with simultaneous CAP determination using the (FibroScan®) M probe. Patients mean age was 45.78 ± 11.6 years, 60.6% were females, mean BMI 26.63 ± 2.75 and 18.1% were cirrhotic. Baseline assessment revealed no steatosis in 43.9%, 32.9% had mild-moderate steatosis and 23.2% had severe steatosis. The overall sustained virological response 12 was 93.6%. Follow-up revealed stationary steatosis in 56.7% of patients and regression in 21.3%. Mean pre-treatment CAP were significantly lower in responders 244.9 ± 62.4 dB/m versus non-responders; 300 ±28.4 dB/m (P = 0.04). ROC curve delineated 273 dB/m as best cutoff for detection of responders with an AUC of 0.801, sensitivity 68.2%, and specificity 100%. BMI significantly increased after treatment (P = 0.004) particularly in patients with worsened steatosis (P = 0.001). Steatosis significantly correlated with BMI (r = 0.3, P value = < 0.001). DAAs causes a significant change in steatosis grade in a subset of treated patients. Pretreatment CAP was significantly lower in responders. BMI significantly increases following treatment particularly in patients with worsened steatosis.

Impact of Direct Acting Antivirals Therapy on Novel Fibrosis Index for Assessment of Hepatic Fibrosis in Comparison with AST to Platelet Ratio and Fibrosis-4 (FIB-4) Indexes in Egyptian Patients with Chronic Hepatitis C Infection in Correlation with Fibroscan

“…The current study showed no significant change between pretreatment and post treatment levels regarding bilirubin level similar to the studies published by Menesy et al (13) , Shousha et al (15) and Russo et al (18) which revealed no significant change of bilirubin level after treatment with DAAs. On the other hand, Alhaddad et al (16) reported a significant decrease in serum bilirubin levels after DAA combined with ribavirin treatment (p < 0.001).…”

“…The current study showed no significant change between pretreatment and post treatment levels regarding INR level similar to Shousha et al (15) who negated any significant change in INR after DAAs therapy. In contrast to Menesy et al (20) revealed that INR showed a significant improvement after DAAs treatment as it decreased from 1.29 down to 1.22 (p = 0.012).…”

“…Another study found that therapy with DAAs resulted in a statistically significant increase in hemoglobin (p <0.001). It had mean values of 13.19 and 12.57 gm/dl before and after treatment respectively done by Shousha et al (15) . Additionally, Alhaddad et al (16) also reported a significant change in hemoglobin level after DAA therapy.…”

Decoupled Glucose and Lipid Metabolic Recovery after Viral Clearance in Direct-Acting Antiviral-Treated HCV Patients: A 3-Year Prospective Cohort Study

“…Increased TC levels [ 13 , 14 ] and BMI [ 37 ] have been consistently reported in CHC patients after viral clearance following DAA therapy. By contrast, there is conflicting evidence on whether insulin sensitivity is improved [ 13 , 20 , 21 , 22 , 23 , 24 ] and how TG and HDL-C levels are altered after SVR following DAA in CHC patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Safety and Efficacy of Directly Acting Antiviral Drugs in Treatment of Chronic HCV Egyptian Patients

“…This agreed with Abdulhameed et al (2020) reported a significant decrease in albumin levels after DAA therapy, but without clinically significant as pre-and post-treatment values were within normal range, with mean values of 4.2 &4.1 gm/l respectively. But, this disagreed with Shousha et al (2018) who in 155 patients of 3 groups according to SOF/DAC/ RBV, SOF/SIM, IFN/SOF/RBV treatment did significant changes in bilirubin level and INR between baseline and 12 weeks post treatment.…”