Hepatitis C Clearance by Direct-Acting Antivirals Impacts Glucose and Lipid Homeostasis

Abstract

Background: Chronic hepatitis C virus (HCV) infections are causally linked with metabolic comorbidities such as insulin resistance, hepatic steatosis, and dyslipidemia. However, the clinical impact of HCV eradication achieved by direct-acting antivirals (DAAs) on glucose and lipid homeostasis is still controversial. The study aimed to prospectively investigate whether antiviral therapy of HCV with DAAs alters glucose and lipid parameters. Methods: 50 patients with chronic HCV who were treated with DAAs were screened, and 49 were enrolled in the study. Biochemical and virological data, as well as noninvasive liver fibrosis parameters, were prospectively collected at baseline, at the end of treatment (EOT) and 12 and 24 weeks post-treatment. Results: 45 of 46 patients achieved sustained virologic response (SVR). The prevalence of insulin resistance (HOMA-IR) after HCV clearance was significantly lower, compared to baseline (5.3 ± 6.1 to 2.5 ± 1.9, p < 0.001), which is primarily attributable to a significant decrease of fasting insulin levels (18.9 ± 17.3 to 11.7 ± 8.7; p = 0.002). In contrast to that, HCV eradication resulted in a significant increase in cholesterol levels (total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein (HDL-C) levels) and Controlled Attenuated Score (CAP), although BMI did not significantly change over time (p = 0.95). Moreover, HOMA-IR correlated significantly with noninvasive liver fibrosis measurements at baseline und during follow-up (TE: r = 0.45; p = 0.003, pSWE: r = 0.35; p = 0.02, APRI: r = 0.44; p = 0.003, FIB-4: r = 0.41; p < 0.001). Conclusion: Viral eradication following DAA therapy may have beneficial effects on glucose homeostasis, whereas lipid profile seems to be worsened.

Glucose and Lipid Profile Changes in Hepatitis C Patients After Direct Acting Antivirals Therapy

“…Our results were also in agreement with (Townsend et al, 2015) who described marked increase in serum low-density lipoprotein cholesterol (LDL-C) in HCV monoinfected or HCV/HIV coinfected patients treated with sofosbuvir and ribavirin (SOF/RBV) or ledipasvir/sofosbuvir combination therapy and report that the increase in serum LDL-C during HCV therapy was independent of the type of HCV therapy, and was likely reflective of the host's response to HCV suppression. In Addition to (EL-Lehleh et al, 2019) [32] who concluded that Successful eradication of HCV was associated with an increase in the serum level of TC, TGs, LDL-C, and HDL-C irrespective of the therapy protocol (DCV + SOF ± RBV), While (Graf et al, 2020) [33] observed a significant increase in total cholesterol, HDL, and LDL during and after antiviral therapy. Moreover, their results show a dynamic change of serum lipid parameters with a significant increase in lipid parameters and CAP (a measure of liver steatosis) values from baseline to follow-up.…”

Differential Expression of the Host Lipid Regulators ANGPTL-3 and ANGPTL-4 in HCV Infection and Treatment

“…Many researchers have reported recovery from HCV-induced hypolipidaemia after DAA treatment [ 66 , 67 , 68 , 69 , 70 ]. However, most studies showed that ANGPTL-targeted lipid species, such as triglycerides and VLDL cholesterol, remained the same before and after DAA treatment, even at 24-week follow-ups [ 66 , 67 , 68 , 71 ]. Alternatively, a moderate post-cure increase was noted only in patients with mild fibrosis [ 70 ].…”

Cerrahi prosedürler öncesi anti-HCV taraması: Hastalar yeterince bilgi sahibi mi?

“…Hastalık ne kadar erken yakalanırsa enfekte kişilerin fayda görme oranı da o kadar artmaktadır (9). DOA ile HCV eradikasyonunun sadece hepatik komplikasyonları azaltmadığı, kardiyovasküler hastalık riskini azalttığı, glisemik kontrol üzerinde etkili olduğuna dair çalışmalar da yayınlanmaktadır (11,12) taların da içinde olduğu toplam 18 hasta tedavi alabilmiş, hepsi SVR 12'ye ulaşmıştır. Bu hastaların kronik karaciğer hastalığının komplikasyonlarından korunabilecek olması önemlidir.…”