Does Obesity Impact Virological Response in HCV Patients on DAA Therapy?

The average BMI of the patients included in the study was 30 (range: 18, 56)
The average BMI of the patients included in the study was 30 (range: 18, 56)

In chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAAs), obesity does not appear to negatively impact virological response, according to results of a retrospective review.

The review analyzed 168 patients treated with an oral DAA at a single center from 2015 to 2017. The patients were placed into 3 groups based on their body mass index (BMI): normal (<25kg/m2), overweight (25-30kg/m2), or obese (>30kg/m2). The study authors defined a sustained virological response as “negative hepatitis C virus (HCV) RNA by polymerase chain reaction 3 months following completion of therapy.” Patients lost during follow-up or co-infected with hepatitis B virus were excluded from the study.

The average BMI of the patients included in the study was 30 (range: 18, 56); 76% of the patients possessed characteristics of metabolic syndrome and 44% had steatosis features. Compensated cirrhosis and decompensated cirrhosis was present in 26.7% and 16.7% of patients, respectively; 74% of patients were genotype (GT)1, 11% were GT2 and GT3, 3 patients were GT3, and 1 patient was GT6. Six patients were NS3/NS5A RAS positive; 17 patients were previously treated with interferon or DAA plus interferon while 4 patients were previously treated with a non-interferon DAA. 

Results of the study also found that 2.3% of patients were co-infected with HIV and taking highly active antiretroviral therapy (HAART) simultaneously.

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The following DAA regimens were prescribed: daclatasvir/sofosbuvir (SOF)+/-ribavirin (RBV), elbasvir/grazoprevir, ledipasvir/SOF+/-RBV, paritaprevir/ritonavir-ombitasvir and dasabuvir +/-RBV, SOF/RBV, SOF/velpatasvir +/-RBV;  89% of patients completed 12 weeks of treatment, at which time, 94.6% (N=159) achieved sustained virological rate (SVR12). The study authors reported, “The average BMI of patients achieving SVR12 was 30; 45% had steatosis features on imaging; 36% had metabolic syndrome; 43% had compensated cirrhosis and 16% had decompensated cirrhosis.” They added, “Out of 159 patients achieving SVR12, 2 had hepatocellular cancer and received local regional therapy, while 1 patient was status post renal transplant and on immunosuppression therapy.” Additionally, of these patients, 3 were also co-infected with HIV and receiving HAART therapy. The average BMI of the 9 patients (5.4%) who did not achieve SVR12 was 29 and one of these patients was reported to have steatosis on imaging.

According to the results of this review, obesity does not impact virological response negatively in CHC patients receiving DAA therapy.

Reference

Tran K, Kuwajima VK, Tahan V. Impact of Obesity on Treatment of Chronic Hepatitis C in Interferon-Free Direct-Acting Antiviral Era. Presented at AASLD The Liver Meeting 2018. Study number 0681.