Weight Gain after Interferon-Free Treatment of Chronic Hepatitis C—Results from the German Hepatitis C-Registry (DHC-R)

Abstract

Chronic hepatitis C can be treated very effectively with direct-acting antivirals (DAA) with only minor side effects compared to an interferon-containing treatment regimen. The significance of metabolic comorbidities after HCV cure is not well defined. This study aims to investigate short- and long-term weight change of patients receiving interferon-free antiviral treatment for chronic hepatitis C. The German Hepatitis C-registry (DHC-R) is a national multicenter real-world cohort. A total of 5111 patients were followed prospectively after DAA treatment for up to 3 years. Weight change compared to baseline was analyzed at end of treatment and at years 1, 2, and 3 after completion of antiviral therapy. Regression analysis was performed to identify baseline predictors for weight change. While there was no relevant mean weight change (−0.2 kg, SD 4.3 kg) at the end of antiviral treatment, weight started to increase during long-term follow-up reaching +1.7 kg (SD 8.0 kg, p < 0.001) compared to baseline at 3 years (follow-up year 3, FU3) after completion of antiviral therapy. 48%, 31%, and 22% of patients had a weight gain greater than 1, 3, and 5 kg at FU3, respectively. During follow-up, a body mass index (BMI) <30 proved to be the only consistent predictor for weight gain. DAA treatment is followed by a substantial weight gain (+3 kg or more) in one-third of the patients during long-term follow-up. Non-obese patients seemed to be most vulnerable to weight gain. The body compartment involved in weight gain as well as the mechanism of weight gain remain to be elucidated.

Changes in Liver Steatosis Using Controlled Attenuation Parameter among Patients with Chronic Hepatitis C Infection Treated with Direct-Acting Antivirals Therapy Who Achieved Sustained Virological Response

“…Weight change was defined as the difference between weight at the baseline and at SVR12. The weight gain was considered as weight change ≥ 1 kg from the baseline to SVR12, and this was chosen to be clinically significant [22].…”

Improvement of liver fibrosis, but not steatosis, after HCV eradication as assessment by MR-based imaging: Role of metabolic derangement and host genetic variants

“…Notably, there was no correlation between steatosis and fibrosis alterations in this study, which might be explained by short-term follow-up after DAA treatment and the occurrence of new-onset steatosis in some patients. Indeed, previous studies in Western populations have demonstrated that weight gain is commonly occur during long-term follow-up after HCV cure with DAAs [ 43 , 44 ]. For instance, a large prospective study of 11,000 veterans in the U.S. indicated that at least 20% of treated patients had excess weight gain within 2 years of achieving SVR [ 43 ].…”

“…For instance, a large prospective study of 11,000 veterans in the U.S. indicated that at least 20% of treated patients had excess weight gain within 2 years of achieving SVR [ 43 ]. A recent report from Germany also showed that a substantial weight gain was identified in one-third of HCV-infected patients, particularly among non-obese individuals [ 44 ]. Additionally, in the mentioned report the progressive weight gain became more evident during long-term follow-up, while no significant weight change was observed early after completing DAA therapy [ 44 ].…”

“…A recent report from Germany also showed that a substantial weight gain was identified in one-third of HCV-infected patients, particularly among non-obese individuals [ 44 ]. Additionally, in the mentioned report the progressive weight gain became more evident during long-term follow-up, while no significant weight change was observed early after completing DAA therapy [ 44 ]. Similarly, increased BMI in our patients was particularly observed during long-term follow-up (FUw72) despite there was no significant weight change at FUw24.…”

Cannabis Use Is Inversely Associated with Metabolic Disorders in Hepatitis C-Infected Patients (ANRS CO22 Hepather Cohort)

“…Pre-DAA diabetes increases mortality and liver-related events independently of HCV cure [ 12 ], and diabetes is also an independent risk factor of de novo hepatocellular carcinoma after DAA treatment [ 16 ]. Weight gain is likely to occur after DAA treatment [ 17 ], while the impact of overweight and obesity on post-HCV cure cirrhosis and hepatocellular carcinoma development remain unclear [ 12 , 18 ]. There is no hard evidence for the benefit of DAA-based HCV cure on elevated blood pressure [ 19 ], and the long-term impact of DAA therapy on serum lipid needs to be investigated [ 20 , 21 ].…”