Metabolic and renal changes in patients with chronic hepatitis C infection after hepatitis C virus clearance by direct‐acting antivirals

Abstract

Background and Aim The impact of hepatitis C virus (HCV) clearance by direct‐acting antiviral agents (DAAs) on HCV‐related extrahepatic manifestations is not well known. We evaluated the effect of viral clearance on metabolic and renal parameters. Methods In this prospective study, HCV patients who achieved a sustained virologic response (SVR) by DAAs were evaluated before, at the end, and 24 weeks after treatment for glycemic (serum glucose and insulin, HOMA‐IR, HOMA‐β, and HOMA‐S) and lipid (serum cholesterol, triglycerides, low‐density lipoprotein [LDL], high‐density lipoprotein) metabolism and renal function (serum creatinine, estimated glomerular filtration rate [eGFR]). Results A total of 343 consecutive HCV patients were evaluated. At 24 weeks of post‐follow‐up, an increase in body mass index (BMI) was observed ( P < 0.05). Regardless of hepatic fibrosis levels and BMI, a reduction in serum glucose ( P = 0.001), HOMA‐IR ( P < 0.001) and HOMA‐β ( P < 0.001) and an increase in HOMA‐S ( P < 0.001) values were observed at 24 weeks after HCV clearance as compared to pretreatment values; 32.4% of patients with impaired fasting glucose normalized serum glucose values and 44.6% of diabetics showed an improvement in glycemic control. In contrast, serum cholesterol ( P < 0.001) and LDL cholesterol ( P < 0.001) values were increased. Renal function was improved with about 10% reduction of serum creatinine values ( P < 0.02) and an increase of eGFR ( P < 0.001). A baseline eGFR of ≤60 mL/min/1.73 m 2 was a negative predictor of renal function improvement. HCV clearance was an independent factor improving glucose metabolism and renal function. Conclusions Our study shows an occurrence of changes in metabolic and renal parameters in HCV patients with SVR, anticipating possible future clinical scenarios that the clinician must know for proper management.

Reduced incidence of type 2 diabetes in patients with chronic hepatitis C virus infection cleared by direct‐acting antiviral therapy: A prospective study

“…Recently, we showed that HCV clearance by DAAs either reversed or improved IR by up to 90%, 13 reduced serum glucose levels and, in more than 30% of people with impaired fasting glucose, normalized their serum glucose values 27 . In addition, it has been reported that HCV clearance by DAAs is associated with improved glycaemic control in people with diabetes, as shown by lower mean HbA1c levels and reduced insulin use 28 …”

“…[24][25][26] Recently, we showed that HCV clearance by DAAs either reversed or improved IR by up to 90%, 13 reduced serum glucose levels and, in more than 30% of people with impaired fasting glucose, normalized their serum glucose values. 27 In addition, it has been reported that HCV clearance by DAAs is associated with improved glycaemic control in people with diabetes, as shown by lower mean HbA1c levels and reduced insulin use. 28 Our findings thus confirm that HCV clearance by DAAs either reverses or improves IR and insulin sensitivity, whilst reducing pancreatic β-cell distress, thus confirming that HCV clearance by DAAs restores HCV-impaired insulin sensitivity.…”

“…Recent studies 27,29 have shown that HCV clearance by DAAs also reduces the risk of cardiovascular disease 29…”

“…Recent studies, 27,29 have shown that HCV clearance by DAAs also reduces the risk of cardiovascular disease 29 and improves kidney function 27 in these patients. It is apparent, therefore, that HCV clearance by DAAs induces a great advantage in terms of reduction of morbidity, mortality and health costs associated with T2DM, as well as the other HCV‐related extrahepatic pathologies.…”

Impact of DAA Treatment on Cardiovascular Disease Risk in Chronic HCV Infection: An Update

“…This viral hypolipidaemia is typically manifested by lower levels of LDL-C and total cholesterol in comparison with non-infected individuals while levels of HDL-C and triglycerides remain unaffected ( Drazilova et al, 2018 ). Recent studies reported rapid changes in serum lipid levels during DAA based therapy manifested as an increase in LDL concentration and in total cholesterol, with no effect on HDL cholesterol levels ( Hashimoto et al, 2016 ; Nevola et al, 2020 ). Further, during the 24 months follow-up period after the DAA treatment, a significant reduction of apoB serum values, a direct marker of LDL-C, was observed ( Gitto et al, 2018 ).…”