Rapid Changes in Serum Lipid Profiles during Combination Therapy with Daclatasvir and Asunaprevir in Patients Infected with Hepatitis C Virus Genotype 1b

Abstract

Background/AimsChanges in lipid profiles in patients infected with hepatitis C virus (HCV) during direct-acting antiviral therapy have been reported in recent years. However, the clinical aspects of disturbed lipid metabolism in chronic HCV infection have not been fully elucidated.MethodsDynamic changes in serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol and apolipoprotein levels in patients infected with HCV genotype 1b were examined during combination therapy with daclatasvir (DCV) and asunaprevir (ASV).ResultsTotal, LDL−, and HDL-cholesterol levels increased rapidly and persistently after week 4. Apolipoprotein (apo) A-I, apo B, apo C-II, and apo C-III levels were significantly higher at week 4 than at week 0. In contrast, apo A-II and apo E levels were significantly lower. The differences in LDL− and HDL-cholesterol levels were positively correlated with those of apo B and apo A-I, respectively. Interestingly, in patients with non-sustained virological response, these cholesterol levels decreased rapidly after viral breakthrough or viral relapse. Furthermore, similar changes were observed for apo A-I, apo B and apo C-III levels.ConclusionsClearance of HCV using combination therapy with DCV and ASV results in rapid changes in serum lipid profiles, suggesting an influence of HCV infection on disturbed lipid metabolism.

Chronic Hepatitis C Association with Diabetes Mellitus and Cardiovascular Risk in the Era of DAA Therapy

“…There are several papers concerning the effect of DAA on the lipoprotein metabolism. Three studies followed patients with genotype 1b exclusively [ 68 – 70 ], five studies dealt with patients with genotype 1 exclusively [ 56 , 66 , 67 , 71 , 72 ], and another five studies followed mostly genotype 1 [ 58 , 65 , 73 – 75 ].…”

“…One study used combination of sofosbuvir + ribavirin [ 56 ], and another used combination of sofosbuvir + simeprevir [ 64 ]. Combination of daclatasvir + asunaprevir was applied also [ 68 ]. Two studies treated patients either with sofosbuvir + ledipasir or daclatasvir + asunaprevir [ 69 , 71 ], and one research applied combinations of either sofosbuvir + ledipasir, daclatasvir + asunaprevir, or sofosbuvir + ribavirin [ 70 ].…”

“…One study observed an increase in TC (LDL-C was not assessed) [ 67 ], and another observed an increase in LDL-C (TC was not assessed) [ 56 ]. In the 12 remaining studies increase of both TC and LDL-C was recorded [ 58 , 64 – 66 , 68 – 75 ]. Three studies described a significantly higher increase in both TC and LDL-C when the combination of sofosbuvir + ledipasvir was used compared to the combination of daclatasvir + asunaprevir [ 68 – 70 ].…”

“…In the 12 remaining studies increase of both TC and LDL-C was recorded [ 58 , 64 – 66 , 68 – 75 ]. Three studies described a significantly higher increase in both TC and LDL-C when the combination of sofosbuvir + ledipasvir was used compared to the combination of daclatasvir + asunaprevir [ 68 – 70 ]. Some of the studies mentioned above assessed HDL-C dynamics also.…”

Direct-acting Antiviral in the Treatment of Chronic Hepatitis C: Bonuses and Challenges

“…And patients with diabetes were noted to have an elevation in cholesterol after treatment (P=0.05 by Wilcoxon test; n=10), but no significant change in triglycerides (P=0.50 by Wilcoxon test; n=7) [48].In line with these results, several clinical studies provided strong evidence that lipoprotein levels and liver lipid accumulation were inclined to normalize after the initiation of combination therapy including sofosbuvir/ribavirin, sofosbuvir/ledipasvir, asunaprevir/daclatasvir and grazoprevir/elbasvir. These modifications appear to be associated with significant improvement of steatosis and atherogenesis [49][50][51][52][53].…”