Metabolic Syndrome and Genotype 1 Virus C Compensated Liver Cirrhosis in the Era of Directly Acting Antiviral Therapy

Abstract

Objectives: The current study aimed at evaluating the association between metabolic syndrome (MeS) in patients with hepatitis C virus (HCV) liver cirrhosis (compensated, genotype, 1b) and changes after sustained viral response (SVR) following a 12-week therapy with paritaprevir, ritonavir, ombitasvir, dasabuvir, and ribavirin (PrOD+R). Methods: The current multicenter retrospective study included 809 patients diagnosed with compensated HCV cirrhosis (child class A), all 1b genotype treated for 12 weeks with direct acting antiviral agents -PrOD+R -regimen (according to the protocol practiced in Romania) and achieved SVR. The parameters of MeS (according to the definition of the International Diabetes Federation) were collected from medical records before and 12 weeks after the treatment. The results were collected in a central database and analyzed with SPSS 18.0. Statistical analysis used both descriptive and analytical methods with a significance level of 95% (CI 95%). Results: Out of the 809 patients, 105 (13%) demonstrated 3 out of the 5 criteria for MeS. Based on the MeS criteria, the commonest parameters were abnormal glycaemia (54.1%), followed by visceral obesity (38.6%), raised triglycerides (26.1%), high blood pressure (12.1%), and a low high-density lipoprotein (HDL)-cholesterol (4.6%). The re-assessment of MeS parameters after SVR showed favourable changes, which were statistically significant: a siginficanttly lower serum triglyeride level (182.32 vs. 153.50 mg/dL, P = 0.001), lower systolic arterial blood pressure (130.57 vs. 124.85 mmHg; P = 0.001), lower diastolic arterial blood pressure (80.26 vs. 78.42 mmHg; P = 0.001) and lower glyceamic levels (130.06 vs. 120.71 mg/dL; P = 0.001), as well as a significant rise in HDL-cholesterol levels (48.61 vs. 50.50 mg/dL; P = 0.003). Abdominal circumference was the only parameter, which did not change after SVR. Following the changes sustained after SVR, 26.7% of the patients no longer fulfilled the minimum 3 criteria for MeS. No correlation was observed between the presence of MeS and the risk of severe adverse events, but it was noted that 37.5% of the patients who decompensated, 66.7% of the ones who developed hepatocarcinoma and 100% of the ones that died of abnormal glycaemic levels. Conclusions: Hyperglycemia, and not MeS, is associated with HCV compensated liver cirrhosis genotype 1b, and is a risk factor for severe adverse events. The attainment of SVR through PrOD+R regimen results in short-term improvements in MeS parameters.

Effect of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, and associated metabolic comorbidities: A systematic review

“…Among the studies that showed an increase in HDL, it appears to be consistent after the viral eradication, whereas during treatment HDL declined 13,91,96 . Higher baseline fibrosis, female sex, and the presence of metabolic syndrome seem to be the factors related to the increase in HDL after SVR 22,45,46,64,72,95 . On the other hand, a low fibrosis stage was associated with a reduction in HDL 61 .…”

“…Baseline insulin and HOMA‐IR were greater in cirrhotic patients compared to noncirrhotic ones 28,54 . After SVR, cirrhotic patients showed a significant reduction in IR, fasting glucose, 21,52,61,72 HbA1c, 62,73 and 2‐h plasma glucose 74 . The amelioration of glycemic parameters in cirrhotic patients seems to be irrespective of BMI and the presence of T2DM, 74 but after SVR, they showed higher HOMA‐IR values compared to patients without baseline advanced fibrosis 58 .…”

“…All studies observed a worsening in TC and LDL after viral eradication by DAAs. Concerning HDL, 17 studies did not show a significant change after SVR, 20 studies observed an increase in HDL after SVR, especially in female patients with metabolic syndrome, 22,45,64,72,95 but not during the treatment when HDL declined, 13,91,96 and only 2 studies revealed a reduction in HDL 61,91 . Finally, 19 studies did not show significant changes in TGs after viral eradication, 13,22,26,40,45,46,53,60,73,74,97–103 in 16 TGs worsened, 12,16,28,36,37,39,52,58,61,64,68,72,91,92,104,105 and in 9 studies TGs decreased after SVR 38,43,54–56,69,79,106,107 …”

miR-155 and miR-21 as Diagnostic and Therapeutic Biomarkers for Ulcerative Colitis: There Is Still a Long Way to Go

“…Despite significant progress in recent years, the etiology of ulcerative colitis (UC) remains poorly understood [1,2]. Likewise, the pathological mechanisms are not fully elucidated.…”

“…Ulcerative colitis (UC) is a potentially severe chronic inflammatory condition of the colon, characterized by periods of activity and remission, with incompletely elucidated etiopathogenesis, in which the immune system interacts with microbiota disorders and/or environmental factors in genetically predisposed individuals [1]. The clinical picture in UC is determined by the extent of the disease and the severity of the inflammation, characterized by the presence of diarrhea and rectal bleeding [2].…”