Hepatitis C eradication with sofosbuvir leads to significant metabolic changes

Abstract

AIMTo assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control.METHODSThis is a retrospective analysis of hepatitis C virus (HCV)-infected patients treated and cured with a SOF regimen [SOF/ribavirin/interferon, SOF/simeprevir, or SOF/ledipasvir (LDV) ± ribavirin] from January 2014 to March 2015. Patients with hemoglobin A1C (HbA1C) and lipid panels within six months before and six months after therapy were identified and included in our study. Due to the known hemolytic effect of ribavirin, HbA1C was obtained a minimum of three months post-treatment for the patients treated with a ribavirin regimen. Medical history, demographics, HCV genotype, pre-therapy RNA, and liver biopsies were included in our analysis. The patients who started a new medication or had an adjustment of baseline medical management for hyperlipidemia or diabetes mellitus (DM) were excluded from our analysis.RESULTSTwo hundred and thirty-four patients were reviewed, of which 60 patients met inclusion criteria. Sixty-three point three percent were male, 26.7% were Caucasian, 41.7% were African American and 91.7% were infected with hepatitis C genotype 1. Mean age was 60.6 ± 6.7 years. Thirty-nine patients had HbA1C checked before and after treatment, of which 22 had the diagnosis of DM type 2. HbA1C significantly decreased with treatment of HCV (pretreatment 6.66% ± 0.95% vs post-treatment 6.14% ± 0.65%, P < 0.005). Those treated with SOF/LDV had a lower HbA1C response than those treated with other regimens (0.26% ± 0.53% vs 0.71% ± 0.83%, P = 0.070). Fifty-two patients had pre- and post-treatment lipid panels; there was a significant increase in low-density lipoprotein (LDL) and total cholesterol (TC) after treatment (LDL: 99.5 ± 28.9 mg/dL vs 128.3 ± 34.9 mg/dL, P < 0.001; TC: 171.6 ± 32.5 mg/dL vs 199.7 ± 40.0 mg/dL, P < 0.001). Pre-treatment body-mass index (BMI) did not differ from post-treatment BMI (P = 0.684).CONCLUSIONEradication of HCV with a SOF regimen resulted in a significant drop in HbA1C and an increase in LDL and TC post therapy.

The Effect of Hepatitis C Virus Eradication with New Direct Acting Antivirals on Glucose Homeostasis in Non-Diabetic Egyptian Patients

“…This is in agreement with several studies [12,[15][16][17]. Abdel Alem et al, found a reduction in both FBS and HbA1c after HCV eradication [18].…”

“…Moreover, some cases were reported to stop insulin therapy after viral eradication [19]. Similarly, Morales et al, proved the reduction of HbA1c in patients with T2DM after treatment with DAA but they failed to explain this improvement [12]. They suggested an improvement of IR after eradication of HCV.…”

Increase of Lipids During HCV Treatment: Virus Action or Medication?

“…On the other hand, other study reported a lipid increase in posttreatment (15) . Concerning DAAs, recent studies suggest that TC and LDL serum levels increase after the end of treatment, whereas triglyceride levels decrease (16,17,18,19) . However, the behavior of serum levels along with the sustained virologic response is not yet clear, that is, whether the relapse or the non-response to treatment could be accompanied by these lipidic alterations.…”

The effect of sustained virological response by direct-acting antivirals on insulin resistance and diabetes mellitus in patients with chronic hepatitis C

“…Several other small retrospective studies [12][13][14][15] have shown a significant improvement of fasting plasma glucose and of glycated hemoglobin A1C in patients who achieved SVR with DAA treatment.…”