Changes in serum zinc levels in hepatitis C patients before and after treatment with direct-acting antiviral agents.

Abstract

Zinc supplementation therapy has been shown to improve the prognosis of patients with hepatitis C virus (HCV) infection. However, little is known about the changes in serum zinc levels with treatment using direct-acting antiviral agents (DAAs). This prospective study investigated the changes in serum zinc levels before and after treatment with DAAs in hepatitis C patients. Thirty-one patients with chronic hepatitis C or HCV-related compensated cirrhosis who were treated with DAAs (glecaprevir/pibrentasvir or elbasvir/grazoprevir) were included in the study. Serum zinc and serum albumin levels were measured before DAA treatment (Baseline), at the end of treatment (EOT), and at 12weeks after EOT (Follow-up 12). The changes over time in the serum zinc and serum albumin levels were investigated. The mean age of the patients was 68.5 ± 12.1 (range, 40-86) years, and 17 (55%) were women. Based on the Japanese Society of Clinical Nutrition diagnostic criteria, 6 patients had zinc deficiency (<60μg/dL), and 21 patients had subclinical zinc deficiency (60-80μg/dL). Significant differences in serum zinc levels were seen between Baseline and EOT (P = 0.01) and between EOT and Follow-up 12 (P = 0.0003). There was no significant difference in serum albumin levels between Baseline and EOT (P = 0.76), but a significant increase was seen between EOT and Follow-up 12 (P = 0.01). Increases in serum zinc are directly related to DAA treatment and are not a result of increases in albumin. Inhibition of the non-structural protein (NS)3 and NS5A by DAAs could be associated with the improvement of serum zinc levels in hepatitis C patients.