Real-Life Early Anthropometric, Lipid and Liver Changes after Direct-Acting Antiviral Therapy in PLWHIV with HCV Co-Infection

Abstract

Treatment with interferon-free direct-acting antivirals (DAA) has become the gold standard in chronic hepatitis C virus (HCV) infection. Nevertheless, little research about the metabolic impact of achieving sustained virological response (SVR) is available in HCV/HIV co-infected patients. This research aimed to evaluate early anthropometric, lipid and liver parameters changes after achieving SVR 12 weeks after treatment (SVR12). A real-life retrospective descriptive before-after study assessed 128 DAA treatment episodes from 2015 to 2019 in HCV/HIV co-infected patients. Anthropometric parameters (weight, body mass index), lipid profile, genotype (GT) and viral load, liver data (basics laboratory necroinflammatory parameters and transient elastography (TE)) were collected before treatment with DAA (baseline), and when SVR12 was achieved. Significant increases (p < 0.01) were found in the early lipid profile, measured by LDLc (84.6 ± 35.0 vs. 108.6 ± 35.1 mg/dL) and total cholesterol (161.3 ± 41.0 vs. 183.3 ± 41.6 mg/dL). Significant changes (p < 0.05) were found in liver parameters, measured by ALT (58.2 ± 34.0 vs. 22.0 ± 16.0 U/L), bilirubin (0.8 ± 0.6 vs. 0.6 ± 0.5 mg/dL), albumin (4.2 ± 0.4 vs. 4.3 ± 0.3 g/dL) and liver stiffness (LS) (13.7 ± 13.3 vs. 11.8 ± 12.1 kPa). The main conclusions were that the use of DAA has an early negative impact on lipid metabolism. Achieving SVR12 against HCV leads to an early improvement in liver function and LS in HCV/HIV co-infected patients without interference with antiretroviral treatment (ART) and DAA. Short-term close lipid monitoring may be necessary when combining protease inhibitors. HCV-GT-3/HIV co-infected patients might require further close monitoring for residual fibrosis. These findings can be relevant for actual clinical practice.

Interferon-free hepatitis C treatment increases a surrogate of atherosclerotic cardiovascular disease risk in Black veterans living with HIV

“…We did not find any significant increases in LDL among VLWH who had advanced liver fibrosis and were on a protease inhibitor. Our finding differs from that of Spaziante et al , and Ferra-Murcia, et al , where participants who were on protease inhibitors (atazanavir and darunavir) in LDL and total cholesterol, respectively [14,15]. NRTIs are still used often as many of the INSTI-based fixed-dose ART combinations use NRTI backbones; however, the threshold for initiating statin therapy may need to be lower after SVR to offset the potential CVD risk exacerbated by abacavir.…”

Evaluating short-term and long-term liver fibrosis improvement in hepatitis C patients after DAA treatment

“…Specifically, we observed that age and AFP levels were associated with short-term improvement in liver fibrosis. Feng et al developed a non-invasive index for predicting significant fibrosis, which included AFP with good predictive performance [25] . Both age and elevated AFP are associated with some biological processes such as inflammation, injury, and regeneration, which in turn influence the course of fibrosis.…”