Study of changes in lipid profile and insulin resistance in Egyptian patients with chronic hepatitis C genotype 4 in the era of DAAs

Figures & data

Table 1. Demographic and baseline characteristics of chronic hepatitis C patients.

Variable	Patients (n = 80) Mean ± SD
Age (years)	47 ± 12 (20–67)
Gender (male/female)	47/33
BMI (kg/m^2)	22.28 ± 1.9 (16–25)
Hypertension (yes/no)	6/59 (9.2%/90.8%)
Smoking (yes/no)	8/72 (10%/90%)
Waist/hip ratio	0.93 ± 0.019 (0.9–0.97)
Hemoglobin (g/dL)	10–17 (13.6 ± 1.3)
Platelets (×10^9)	194.4 ± 58 (81–430)
Albumin (gm/L)	4.15 ± 0.6 (2.1–5.4)
INR	1.1 ± 0.1 (0.9–1.4)
Creatinine (mg/L)	0.94 ± 0.18 (0.64–1.6)
Total bilirubin (mg/L)	0.46 ± 0.2 (0.1–1.2)
ALT (IU/L)	50.1 ± 20.0 (21–103)
AST (IU/L)	50.8 ± 25.8 (17–163)
AFP	3.6 ± 3.8 (0.7–32.8)
Fasting glucose (mmol/dL)	5.04 ± 0.75 (3.33–6.67)
Insulin level (uU/L)/ml)	20.15 ± 5.13 (5–29)
HOMA-IR	4.49 ± 1.28 (1.25–7.25)
HOMA-IR (<3 and ≥3)	(33 and 47) (58.8% and 41.3%)
Triglycerides (mg/dL)	98 ± 40.8 (35–225)
HDLC (mg/dL)	42.1 ± 5.8 (31–58)
LDL-C (mg/dL)	63 ± 29 (11–131)
LDL/HDL	1.7 ± 0.8
Cholesterol (mg/dL)	126 ± 28 (70–195)
Viral load (log10)	5.2 + 1.3 (2.04–7.9)
Fibrosis stage (Fibro scan):
F1	15 (18.8%)
F2	24 (24%)
F3	17 (21.2%)
F4	24 (35%)
(F1, F2, F3, F4)	(39–41) (48.8–51.2%)
FIB-4	1.9 ± 1.1

BMI: body mass index; ALT: alanine transaminase; AST: aspartate transaminase; INR: International normalized ratio; HOMA-IR: homostatsis model assessment of insulin resistance; HDLc: high-density lipoprotein cholesterol; AFP: alpha foetoprotein; U/S: ultrasound. P values ≤0.05 are significant.

Table 2. Baseline metabolic data and lipid profile in chronic hepatitis C (CHC) patients versus the control group.

Variable	Patients (n = 80) Mean ± SD	Controls (n = 40) Mean ± SD	P
Cholesterol (mg/dL)	126 ± 28	137 ± 30.8	0.1
TG (mg/dL)	100.5 ± 36.1	82 ± 27	0.006
LDL-c	63.4 ± 29	79.6 ± 33.7	0.3
HDLc	39.4 ± 5.3	45.2 ± 5.23	0.776
LDL-c/LDL-c	1.72 ± 0.8	1.74 ± 0.9	0.8
Fasting glucose (mmol/dL)	5.04 ± 0.75	4.7 ± 0.52	0.01
Fasting insulin level (uU/L)/ml)	20.15 ± 5.13	13.15 ± 4.2	0.001
HOMA-IR	4.49 ± 1.28	2.72 ± 0.87	0.001

TG: triglycerides; LDL-c: low-density lipoprotein cholesterol; HDLc: high-density lipoprotein cholesterol; HOMA-IR: homostatsis model assessment of insulin resistance. P values ≤0.05 are significant.

Table 3. Metabolic factors, lipid profile, according to fibrosis stage in chronic hepatitis C patients.

Variable	(F0 to F2) n (36) Mean ±SD	(F3 to F4) n (44) Mean ±SD	P
Cholesterol (mg/DL)	127 ± 28	125 ± 28	0.9
TG (mg/dL)	102.4 ± 39	99.32 ± 4	0.7
LDL-c	63.8 ± 27.5	62 ± 30	0.4
HDLc	39.3 ± 5	39.6 ± 5.4	0.5
LDL-c/LDL-c	1.7 ± 0.8	1.69 ± 0.77	0.78
Fasting glucose (mmol/dL)	5.03 ± 0.81	5.06 ± 0.7	0.895
Fasting insulin (uU/L)/ml)	19.2 ± 5.4	21.7 ± 4.4	0. 025
HOMA-IR	4.28 ± 1.3	4.7 ± 1.24	0.154

TG: triglycerides; LDL-c: low-density lipoprotein cholesterol; HDLc: high-density lipoprotein cholesterol; HOMA-IR: homostatsis model assessment of insulin resistance. P values ≤0.05 are significant.

Table 4. Changes in laboratory data and imaging before and at the end of treatment with SOF/SIM (12 months) in CHC patients.

Variable	Before treatment Mean ±SD	End of treatment Mean ±SD	P
Hb (g/dL)	13.6 ± 1.3	12.7 ± 1.5	0.001
Platelets (×10^9/L)	196.09 ± 59.1	194.6 ± 37.06	0.7
ALT (U/L)	49.8 ± 21.4	41.6 ± 14.4	0.001
AST (U/L)	50.2 ± 25.2	40.2 ± 17.3	0.001
FIB-4	1.9 ± 1.08	1.7 ± 1.1	0.03
Fibroscan	13.6 ± 10.4	12.6 ± 8.8	0.001

TG: triglycerides; LDL-c: low-density lipoprotein cholesterol; HDLc: high-density lipoprotein cholesterol; HOMA-IR: homeostasis model assessment of insulin resistance. P values ≤0.05 are significant.

Table 5. Changes of metabolic factors, lipid profile before and after the end of treatment of SOF/SIM treatment (12 weeks) in CHC patients.

Variable	Before treatment Mean ±SD	End of treatment Mean ±SD	P
TG (mg/dl)	100.5 ± 36	81.7 ± 31.9	0.001
Cholesterol (mg/dl)	126.1 ± 28.2	143 ± 38.5	0.001
LDL (mg/dl)	63.4 ± 28.9	84.8 ± 38.1	0.001
HDL (mg/dl)	39.4 ± 5.3 (28–51)	42.9 ± 5.9 (30–58)	0.001
LDL/HDL	1.7 ± 0.8	2 ± 0.87	0.04
FBS (mmol/L)	5.04 ± 0.75	4.7 ± 0.52	0.001
Fasting insulin (uU/L)/ml)	20.15 ± 5.13	15.7 ± 7.4	0.001
HOMA-IR	4.49 ± 1.28	3.06 ± 0.01	0.001

TG: triglycerides; LDL-c: low-density lipoprotein cholesterol; HDLc: high-density lipoprotein cholesterol; HOMA-IR: homeostasis model assessment of insulin resistance. P values ≤0.05 are significant.

Figure 1. Changes in lipid profile, FBS, fasting insulin, and HOMA-IR in 80 chronic hepatitis C patients before and at the end of treatment with SOF/SIM. The charts show the changes in lipid profile, FBS, fasting insulin, and HOMA-IR in chronic hepatitis C (HCV) patients before and at the end of treatment (12 weeks) with SOF/SIM. LDL-c: low-density lipoprotein cholesterol; HDL: high-density lipoprotein cholesterol; TG: triglycerides; FBS: fasting blood sugar.

Table 6. Factors associated with ΔLDL-C value with HCV administered SOF/SIM regimen, analyzed by multiple logistic-regression analysis.

Variable	Sig.	OR (95% CI)
Age (years)	0.552	1.012 (0.974–1.051)
BMI (kg/m^2)	0.537	0.868 (0.554–1.361)
Gender (male/female)	0.198	1.897 (0.716–5.029)
ALT (U/L)	0.322	0.974 (0.926–1.026)
AST (U/L)	0.559	0.986 (0.939–1.035
T bilirubin (mg/L)	0.300	2.972 (0.380–23.267)
Albumin (g/L)	0.647	0.734 (0.195–2.763)
Hemoglobin (gm/dL)	0.987	0.995 (0.535–1.849)
Platelets (×10^9/L)	0.677	0.997 (0.983–1.011)
WBCs (×10^3)	0.771	1.000 (1.000–1.000)
Log of viral load (log10)	0.429	1.000 (1.000–1.000)
HOMA-IR	0.179	0.601 (0.286–1.263)
Fasting insulin (uU/L)/ml)	0.395	0.859 (0.606–1.219)
Fasting sugar (mmol/dL)	0.919	1.093 (0.196–6.097)
HOMA- IR	0.305	2.948 (0.374–23.229)
Cholesterol (mg/dL)	0.001	1.066 (1.031–1.102)
TG (mg/dL)	0.342	0.989 (0.967–1.012)
HDLC (mg/dL)	0.435	0.941 (0.807–1.097)
Stage of fibrosis (F1–F4)	0.026	1.162 (1.018–1.328)

BMI: body mass index; ALT: alanine transaminase; AST: aspartate transaminase; HOMA-IR: homostatsis model assessment of insulin resistance; HDLc: high-density lipoprotein cholesterol. P values ≤0.05 are significant.