Hep C Eradication Triggers Significant Lipid, Glucose Changes

SAN FRANCISCO, CA—The benefits of eradicating hepatitis C virus (HCV) infection with sofosbuvir may go well beyond avoiding the damage caused by chronic liver inflammation, to include declines in glycated hemoglobin (HbA1c) and other metabolic parameters, according to a study reported at The Liver Meeting® 2015. 

The study showed "a significant drop" in HbA1c of approximately 0.5 units, "and elevation in LDL and total cholesterol up to 6 months after eradication of HCV with a sofosbuvir regimen," reported Amilcar L. Morales, MD, and colleagues at Walter Reed National Military Medical Center.

"Our study shows that all sofosbuvir regimens have the same effect on lipids, suggesting that it's related to viral clearance and not medication specific," he added.

HCV infection is known to cause metabolic complications, including insulin resistance and changes in lipid metabolism, by inducing inflammatory cascades. By eradicating the virus, pathway homeostasis is restored. 

The study team reviewed charts of 234 patients with confirmed HCV infections treated and cured with sofosbuvir therapy from November 2014 to March 2015, identifying those with HbA1c and/or a lipid panel that had been drawn 6 or more months prior to treatment initiation and at least 6 months after completing therapy.

"In patients treated with ribavirin, the post-treatment HbA1c was selected between 3 to 6 months post-therapy due to concerns of drug-induced hemolysis," they noted.

A total of 60 patients were included in the final analysis; 63.3% were male, 41.7% were African American, and mean age was 60.6 years. Preexisting conditions included diabetes (38.3%), hyperlipidemia (33.3%), and hypertension (70.0%); 20.0% were using statins. HCV genotype was 1a (50.0%), 1b (26.7%), 1 (not defined 15.0%), 2 (3.3%), and 3 (5.0%); 25.0% of patients were cirrhotic.

Treatments for HCV included sofosbuvir/ribavirin/interferon (35.0%), sofosbuvir/simeprevir (18.3%), sofosbuvir/ledipasvir (38.3%), and sofosbuvir/ribavirin (8.3%).

HbA1c levels significantly decreased with HCV treatment (pretreatment 6.66mg/dL vs. post-treatment 6.13mg/dL; P=0.005), the researchers found. In addition, significant increases in LDL and total cholesterol were observed; for LDL, 99.5mg/ dL vs. 128.3mg/dL; P<0.001; and for total cholesterol, 171.6mg/dL vs. 199.7mg/dL; P<0.001).

HDL levels decreased from 52.8mg/dL to 51.4mg/dL and triglycerides, from 132.1mg/dL to 129.8mg/dL, they noted.

No difference in HbA1c effect was noted between genotype 1a vs. 1b (P=0.605), gender (P=0.793), or race (P=0.297). There was no correlation between viral load and HbA1c decrease (R=0.05) or LDL increase (R=0.21). Patients with diabetes showed a greater drop in HbA1c than those without diabetes, 0.73 vs. 0.22 (P=0.041).

These results suggest that physicians treating patients with HCV "should reassess preventive medicine measures after therapy,” he concluded.

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