Assessment of Changes in Liver Fibrosis and Stiffness, Lipid Profile and Insulin Resistance in Patients with Chronic Hepatitis C Viral Infection Who Received Direct Acting Antiviral Therapy

Abstract

Background: With introduction of direct acting antivirals (DAAs) in the management of chronic hepatitis C viral (HCV) infection, this leads to high frequency of sustained viral response (SVR). Effect of these agents on liver stiffness and lipid isn't well studied. Objective: We tried to assess changes in liver stiffness, insulin resistance (IR) and lipid profile after achievement of SVR with DAAs. Patients and methods: A total of 80 patients with chronic HCV infection were recruited in the study. All patients received dual therapy of sofosbuvir and daclatasvir either without ribavirin (in case of chronic hepatitis) or with ribavirin (in case of liver cirrhosis). Liver stiffness, lipid profile and IR were assessed at baseline and at the end of therapy. Results: All patients achieved SVR. Majority (58.8%) of patients were males. There was significant improvement in liver transaminases after therapy. There was significant reduction in frequency of IR after therapy (42.5% vs. 68.7%; p= 0.04) with percentage of decrease was 16.11%. Also, there was significant decrease in degree of fibrosis as assessed by fibroScan with percentage of decrease was 48.2%. Predictors for persistence IR after DAAs therapy were only body mass index and advanced fibrosis. Cholesterol, low density lipoproteins and triglycerides showed significant increase after therapy. Conclusion: Sofosbuvir and daclatasvir with or without ribavirin are effective and tolerable agents in management of chronic HCV infection. Degree of liver fibrosis and insulin resistance would be reduced after DAAs therapy. Future multi centers are warranted to confirm these findings.