Cure or curd: Modification of lipid profiles and cardio‐cerebrovascular events after hepatitis C virus eradication

Abstract

Hepatitis C virus (HCV) eradication deteriorates lipid profiles. Although HCV eradication may reduce the risk of vascular events as a whole, whether deteriorated lipid profiles increases the risk of cardio‐cerebral disease in certain patients is elusive. Serial lipid profiles were measured before, during, at and 3 months after the end of direct‐acting antivirals (DAAs) therapy, and annually thereafter in chronic hepatitis C patients who achieved a sustained virological response (SVR, undetectable HCV RNA at posttreatment week 12). The primary end‐point was the occurrence of the events. A total of 617 patients were included, with a mean follow‐up period of 26.8 months (range: 1‐65 months). The total cholesterol and low‐density lipoprotein cholesterol (LDL‐C) levels increased significantly from treatment week 4 to 2 years after treatment. Logistic regression analysis revealed that the factors independently associated with a significant cholesterol increase included age (odds ratio [OR]/95% confidence intervals [CIs]:1.02/1.006‐1.039, P = .007) and smoking (OR/CI:3.21/1.14‐9.02, P = .027). Five patients developed cardio‐cerebral diseases during 1376 person‐years follow‐up period. Compared to patients without vascular events, a significantly higher proportion of those with vascular events experienced an LDL‐C surge >40% (80% vs 19.9%, P = .001). Cox‐regression analysis revealed that an LDL‐C surge >40% was the only factor predictive of vascular events (HR/CI: 15.44/1.73‐138.20, P = .014). Dyslipidemia occurred after HCV eradication, and it was associated with the risk of cardio‐cerebrovascular diseases. Attention should also be paid to the extrahepatic consequence beyond liver‐related complications in the post‐SVR era.

Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

“…For patients without a history or risk of cardiovascular complications, lipid-lowering agents might be held for 8-12 weeks with close monitoring of serum lipid profiles for potential lipid rebound and risk of significant cardiovascular events. 41 Several PPIs are categorized as having orange-category DDIs to SOF/LDV, SOF/VEL, and SOF/VEL/VOX due to pH-dependent solubility issues. In accordance with the prescribing information, SOF/LDV and SOF/VEL/VOX can be administered simultaneously with a lowdose PPI (defined as daily dose comparable to 20 mg of omeprazole or lower).…”

MAFLD considerations as a part of the global hepatitis C elimination effort: an international perspective

“…A recent study of 617 patients suggested that an low-density lipoprotein surge >40% during the follow-up period of 26.8 months (range: 1-65 months) was associated with development of cardio-cerebral vascular diseases. 59 Further work suggested that a combination of an increased small-dense lowdensity lipoprotein, which purportedly has greater atherogenic potential, and liver steatosis, as measured by elastographic CAP in SVR patients after DAAs, is associated with a potential synergistic risk on atherosclerosis. 51 Additionally, various studies highlighted an increase in hepatic steatosis after SVR.…”

“…Although, it is well established that HCV eradication reduce cardio‐cerebral vascular risk, 54‐58 some special subpopulation might be maintained at higher risk. A recent study of 617 patients suggested that an low‐density lipoprotein surge >40% during the follow‐up period of 26.8 months (range: 1‐65 months) was associated with development of cardio‐cerebral vascular diseases 59 . Further work suggested that a combination of an increased small‐dense low‐density lipoprotein, which purportedly has greater atherogenic potential, and liver steatosis, as measured by elastographic CAP in SVR patients after DAAs, is associated with a potential synergistic risk on atherosclerosis 51 …”

Path from the discovery to the elimination of hepatitis C virus: Honoring the winners of the Nobel Prize in Physiology or Medicine 2020

“…Meanwhile, increase in total cholesterol and low‐density lipoprotein cholesterol (LDL‐C) have been reported in the post‐SVR phase. An LDL‐C surge of >40% occurring after HCV eradication was associated with increased risks of vascular events, urging more caution and research in this phenomenon 25 …”