Worsening of Serum Lipid Profile after Direct Acting Antiviral Treatment
Journal Title: Annals of Hepatology - Year 2018, Vol 17, Issue 1
Abstract
Introduction. Host lipid metabolism influences viral replication and lifecycle of hepatitis C virus. Our aim was to evaluate changes in glucose and lipid metabolism of patients with chronic hepatitis C after therapy with direct acting antivirals (DAA). Material and methods. We considered patients consecutively treated between January and November 2015 recording clinical data at baseline and week 24 of follow-up. Frozen serum samples were used for apolipoprotein A1 (apoA1), apolipoprotein B (apoB) and lipoprotein (a) [Lp(a)]. Wilcoxon test was utilized to estimate trends and Logistic Regression for predictors of lipid changes. Results. We enrolled 100 patients, mostly cirrhotic (81%) and with genotype 1b (59%). Ninety-three patients achieved sustained virological response (SVR), while 7 relapsed. Homeostasis model assessment of insulin resistance declined (from 3 to 2.7, p < 0.001); non-high density lipoprotein (HDL) cholesterol increased from 102 ± 29 to 116 ± 35 (p < 0.001), and Lp(a) from 5.6 ± 6.5 to 9.8 ± 11.5 mg/dL (p < 0.001). Rise of low-density lipoprotein/HDL and apoB/apoA1 ratio were registered (from 1.79 ± 1.10 to 2.08 ± 1.05 and from 0.48 ± 0.18 to 0.53 ± 0.18 mg/dL, p < 0.001). We conducted a subanalysis on patients with relapse. In this subgroup, no change of lipid profile was recorded. At multivariate analysis emerged that the addition of ribavirin to DAA, represented an independent predictor of increased Lp(a) (OR 3.982, 95% CI 1.206-13.144, p = 0.023). Conclusion. DAA therapy led to reduction of insulin resistance. In contrast, pro-atherogenic lipid changes were observed in patients with SVR. Further studies will be necessary to evaluate the cardiovascular balance between amelioration of glucose metabolism and negative changes of lipid profile.
Authors and Affiliations
Stefano Gitto, Arrigo F. G. Cicero, Elisabetta Loggi, Marina Giovannini, Fabio Conti, Elena Grandini, Valeria Guarneri, Alessandra Scuteri, Giovanni Vitale, Carmela Cursaro, Claudio Borghi, Pietro Andreone
Keywords
Related Articles
- EP ID EP247958
- DOI 10.5604/01.3001.0010.7536
- Views 93
- Downloads 0
High ghrelin and obestatin levels and low risk of developing fatty liver
Aim. Obesity and insulin resistance are associated with nonalcoholic fatty liver disease (NAFLD). It was recently reported that the ratio between levels of ghrelin and obestatin is also associated with obesity and insuli...
Hepatogenous diabetes. Current views of an ancient problem
Diabetes developed as a complication of cirrhosis is known as hepatogenous diabetes» (HD). Around 30% to 60% of cirrhotic patients suffer from this metabolic disorder. Insulin resistance in muscular, hepatic and adipose...
The safety and feasibility of large volume paracentesis performed by an experienced nurse practitioner
Due to time constraints, fewer physicians are performing large volume paracentesis (LVP) resulting in a longer wait time and more emergency department (ED) and hospital admissions. At our institution, after initial super...
Alopecia universalis after discontinuation of pegylated interferon and ribavirin combination therapy for hepatitis C: a case report
For the last decade, the combination therapy of pegylated interferon (Peg-IFN) plus ribavirin (RBV) hasbeen considered as the standard of care treatment for chronic hepatitis C virus (HCV) infection. However, it has been...
Cholestatic hepatitis C after chemotherapy containing rituximab in diffuse large B cell lymphoma
Rituximab is a chimeric anti-CD20 monoclonal antibody that is a widely used for the treatment of B cells non-Hodgkin lymphoma. The use of chemotherapy regimens containing rituximab in HCV-positive patients with non-Hodgk...