Impact of direct-acting antiviral therapy on metabolic profiles and adiponectin serum level in different categories of patients with chronic hepatitis C infection

Abstract

Background Infection with the hepatitis C virus (HCV) is a worldwide health problem. HCV infection is linked to a variety of metabolic abnormalities as it interferes with lipid metabolism, causing steatosis and a wide range of adipocytokine alterations, as well as impairing glucose metabolism, resulting in a rising prevalence of insulin resistance (IR) and type 2 diabetes. Over the last few years, numerous oral anti-HCV medicines (direct-acting antivirals; DAAs) have been introduced. With DAA therapy, HCV can now be eradicated from the infected host within 12 weeks. There is a need for more research because there is minimal information on the effects of DAA therapy on metabolic profiles, lipid profiles, and adiponectin levels. Thus, the purpose of this study was to see how direct-acting antivirals (DAAs) affected metabolic profiles and serum adiponectin levels in 2 different categories of Egyptian patients with chronic hepatitis C infection. This study included 100 patients with chronic HCV who were separated into two groups. Group I consisted of 50 patients who were treated for 12 weeks with sofosbuvir, daclatasvir, and ribavirin). Group II consisted of 50 patients who were treated for 12 weeks with ombitasvir, paritaprevir, and ritonavir/ribavirin. This regimen was chosen because these patients had an eGFR of 30 ml/min. Fasting lipid profiles (total cholesterol, triglyceride, HDL, and LDL), metabolic profiles (fasting blood sugar, fasting insulin, HOMA-IR, and HbA1C), and serum adiponectin levels were measured before and after the end of treatment. Results Statistical analysis of the data showed a significant difference in the lipid profile in group I before and after treatment, as we found a significant reduction in serum triglycerides after treatment (113.2 ± 22.9 mg/dL vs 105.6 ± 23.2 mg/dL, P < 0.001) and a significant elevation of serum total cholesterol, LDL, and HDL after treatment (TC: 153.2 ± 20.1 mg/dL vs 174.1 ± 19 mg/dL, P < 0.001; LDL: 74.7 ± 9.9 mg/dL vs 93.3 ± 12 mg/dL, P < 0.001; HDL: 54.6 ± 10.1 mg/dL vs 57.2 ± 10.3 mg/dL, P 0.010). But in group II, there was no significant difference in the lipid profile before and after treatment. We also found a significant reduction in fasting insulin, HOMA-IR, and HBA1C after treatment in group I (fasting insulin: 11.4 ± 3.3 (µU/L)/ml vs 9.7 ± 2.2 (µU/L)/ml, P < 0.001; HOMA-IR: 2.7 ± 0.9 vs 2.2 ± 0.6, P < 0.001; HBA1C: 5.6 ± 0.4 vs 5.4 ± 0.3, P 0.003). But in group II, there was no significant difference in fasting insulin, HOMA-IR, and HBA1C before and after treatment. Also, we found that there were no significant changes in the serum adiponectin level in either group before or after treatment. Conclusion HCV clearance with DAAs had an impact on the lipid and metabolic profiles of the patients at the end of treatment. This could depend on the type of DAAs used in the treatment, the stage of the liver disease, and the associated conditions of patients. However, serum adiponectin levels are unaffected.

The effect of different direct antivirals on hepatic steatosis in nondiabetic and naïve hepatitis C-infected Egyptian patients

“…All patients in our study achieved SVR-12. This success rate is similar to many studies done after the introduction of DAAs [ 18 – 20 ]. Our study population is selected with a normal baseline metabolic profile, despite being chronically infected by HCV.…”

“…This could be attributed to the baseline metabolic state of their cohort, as two-thirds of the included patients had a hyperlipidemic state prior to treatment [ 4 ]. Another study, in our Ain Shams virology treatment center, done on HCV-infected patients with decreased eGFR (of 30 ml/min or less), they found that after achieving SVR, the triglycerides levels, and HbA1C, were decreased, while the total cholesterol, LDL, and HDL levels were increased [ 18 ].…”

“…of DAAs [18][19][20]. Our study population is selected with a normal baseline metabolic profile, despite being chronically infected by HCV.…”

Evaluation of the effect of direct-acting antiviral agents on melatonin level and lipid peroxidation in chronic hepatitis C patients

“…B) Group that is difficult to treat according to these standards: Having received Peg-INF treatment, having total serum bilirubin levels greater than 1.2 mg/dL, serum albumin levels lower than 3.5 g/dL, having an INR greater than 1.2, and having a platelet count below 150,000/mm3. This group is eligible to get a 12-week course of sofosbuvir, daclatasvir, and ribavirin treatment ( Allam et al, 2022 ).…”