Excess Weight Gain After Cure of Hepatitis C Infection with Direct-Acting Antivirals

Abstract

BACKGROUND: Cure from chronic hepatitis C virus (HCV) infection is readily achievable with direct-acting antivirals (DAA), but little is known about optimal management after treatment. Weight gained after DAA treatment may mitigate benefits or increase risk for liver disease progression. As the single largest sample of HCVinfected individuals receiving DAA treatment in the United States, the Veterans Affairs (VA) Birth Cohort is an ideal setting to assess weight gain after DAA treatment. METHODS: We performed a prospective study of patients dispensed DAA therapy from January 2014 to June 2015. Weight change was calculated as the difference in weight from sustained virologic response (SVR) determination to 2 years later. Demographic, weight, height, prescription, laboratory, and diagnosis code data were used for covariate definitions. We used multiple logistic regression to assess the association between candidate predictors and excess weight gain (≥ 10 lbs) after 2 years. RESULTS: Among 11,469 patients, 78.0% of patients were already overweight or obese at treatment initiation. Overall, SVR was achieved in 97.0% of patients. After 2 years, 52.6% of patients gained weight and 19.8% gained excess weight. In those with SVR, weight gain was as high as 38.2 lbs, with the top 10% gaining ≥ 16.5 lbs. Only 1% of those with obesity at treatment initiation normalized their weight class after 2 years. Significant predictors of post-SVR weight gain were SVR achievement, lower age, high FIB-4 score, cirrhosis, and weight class at treatment initiation. CONCLUSION: Weight gain is common after DAA treatment, even among those who are overweight or obese prior to treatment. Major predictors include age, baseline weight, alcohol, cirrhosis, and SVR. Everyone receiving DAAs should be counseled against weight gain with a particular emphasis among those at higher risk.

Only partial improvement in health‐related quality of life after treatment of chronic hepatitis C virus infection with direct acting antivirals in a real‐world setting—results from the German Hepatitis C‐Registry (DHC‐R)

“…As an independent predictor for a further decline in MCS after DAA therapy, a BMI of >30 kg/m 2 was evaluated for patients with low BL values. This finding might be in line with results of previously performed studies, showing weight gain in up to 52% of patients treated with DAA, even among those who are overweight at treatment BL 47,48 . The prevalence of steatosis and steatohepatitis in obese patients was determined before by histological findings in a minimum of 65% and 20%, respectively (notably influenced by ethical background and genetic variation) 49 and NAFLD was reported as an independent predictor of poorer HRQoL compared to HCV‐infected patients, 50 associated with hepatic inflammation levels 51 .…”

“…This finding might be in line with results of previously performed studies, showing weight gain in up to 52% of patients treated with DAA, even among those who are overweight at treatment BL. 47,48 The prevalence of steatosis and steatohepatitis in obese patients was determined before by histological findings in a minimum of 65% and 20%, respectively (notably influenced by ethical background and genetic variation) 49 and NAFLD was reported as an independent predictor of poorer HRQoL compared to HCV-infected patients, 50 associated with hepatic inflammation levels. 51 The absence of improvement or even further decline in MCS therefore may be associated with a coincidently existent NAFLD component in obese HCV-infected patients.…”

Residual risk of liver disease after hepatitis C virus eradication

“…This increase was deemed of interest considering an expected weight gain associated with aging (0.45 to 0.9 kg per year). 33 SVR was an independent predictor of weight gain together…”

MAFLD considerations as a part of the global hepatitis C elimination effort: an international perspective

“…A large American study of 11,469 DAAs‐treated patients showed that while 78% of patients were already overweight or obese at DAA treatment initiation, 53% of patients gained weight and 20% gained excess weight (defined as weight change ≥10 lbs over the 2‐year observation period) after 2 years of follow‐up. Achieving SVR was an independent predictor of weight gain 50 . There is also strong evidence showing an increase in total cholesterol and low‐density lipoprotein (LDL) levels after HCV eradication with DAA 48,49,51,52 .…”

“…Achieving SVR was an independent predictor of weight gain. 50 There is also strong evidence showing an increase in total cholesterol and low-density lipoprotein (LDL) levels after HCV eradication with DAA. 48,49,51,52 Another study also confirmed the significant increase in low-density lipoprotein and total cholesterol, regardless of the degree of hepatic fibrosis, while no significant change in lipid profile was noticed in both untreated and non-SVR patients.…”