Hepatitis C clearance by direct-acting antivirals impacts glucose and lipid homeostasis

  • 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.

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Author:Christiana GrafORCiDGND, Tania Mara WelzelGND, Dimitra Bogdanou, Johannes VermehrenGND, Anita Beckel, Jörg BojungaGND, Mireen Friedrich-RustORCiDGND, Julia DietzORCiDGND, Alica KubeschORCiDGND, Antonia Maria MondorfORCiDGND, Sarah Fischer, Thomas Lutz, Philipp Clemens StoffersORCiDGND, Eva HerrmannORCiDGND, Thierry PoynardORCiDGND, Stefan ZeuzemORCiDGND, Georg DultzORCiDGND, Ulrike Mihm
Parent Title (English):Journal of Clinical Medicine
Place of publication:Basel
Document Type:Article
Date of Publication (online):2020/08/21
Date of first Publication:2020/08/21
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/09/22
Tag:direct-acting antivirals; hepatic fibrosis; hepatitis C virus; insulin resistance
Issue:(9), article 2702
Page Number:11
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0