Lipids, glucose and iron metabolic alterations in chronic hepatitis C after viral eradication – comparison of the new direct-acting antiviral agents with the old regimens

Abstract

Background: Hepatitis C virus (HCV) is a unique virus which interacts with cholesterol, iron and insulin metabolism. There is limited data on the effects of direct-acting antiviral agents (DAAs) on metabolic profiles. We aimed at evaluating the behavior of metabolic risk factors of chronically HCV-infected patients after sustained virologic response (SVR), comparing the outcomes with the new DAAs versus the old treatment regimen Peg-interferon ± ribavirin.

Methods: A total of 178 patients who achieved SVR and completed one year of follow-up were prospectively included in this study: group 1 with 105 patients treated with DAAs and group 2 with 73 patients treated with old regimens. Outcomes included lipid, glucose and iron metabolism variation after SVR.

Results: There was a significant increase in total cholesterol in both groups (group 1: p < .001, 95% CI: 0.41–0.78; group 2: p < .001, 95% CI: 0.24–0.69). Triglyceride levels significantly decreased (p = .015, 95% CI: −0.33–0.04) in group 1 and increased (p = .014, 95% CI: 0.07–0.59) in group 2. LDL levels increased in group 1 (p = .029, 95% CI: 0.05–0.88), but no significant variation was found in group 2. No significant variation in HDL, fast glucose and iron was seen in both groups. There was a significant increase of HOMA (p = .002, 95% CI: 0.17592–0.72317) only in group 2. Ferritin serum levels significantly decreased (p < .001, 95% CI:−138.3–74.4) in group 1 but no significant variation was found in group 2.

Conclusion: Patients who have achieved SVR may have increased risk of cardiovascular outcomes due to development of hyperlipidemia and insulin resistance.

Keywords:

• Hepatitis C virus
• lipids
• iron
• glucose
• metabolism
• direct-acting antiviral agents

Disclosure statement

No potential conflict of interest was reported by the authors.