Lipid kinetics during dual antiviral therapy in patients with chronic hepatitis C

Abstract

Background and objectiveWe analysed baseline and kinetic characteristics of lipid metabolism during the first month of bitherapy in patients with chronic hepatitis C genotype 1 (CHC-1). Patients and methodsA longitudinal, prospective study including 99 naïve CHC-1 patients with liver biopsy who were treated with bitherapy. Our patients were assigned to one of the 5 different “degrees of lipid requirement” that we established depending on the degree of liver fibrosis, baseline viral load and infectivity ratio (ratio between the median level of triglycerides and high density lipoproteins-cholesterol during the first month). The goal was to achieve “a favourable lipid metabolism” (FLM) by establishing a necessary minimum level of low density lipoproteins (LDL)-cholesterol during this period for each one of them. We also analysed the relationship with the rate of sustained virological response. ResultsPatients with liver fibrosis F3-F4 who had higher baseline levels of LDL-cholesterol achieved higher rates of sustained virological response. Those patients who had a lower value of infectivity ratio and median levels of LDL-cholesterol during the first month of bitherapy also achieved higher rates of sustained virological response: SVR group 100 (23) mg/dl against non-SVR group: 89 (28) mg/dl; odds ratio 1.1; 95% confidence interval (1.0–1.2); P<0.05, these differences being more significant for genotype IL-28B-CC (P=0.013). Patients with sustained virological response had higher rates of FLM. ConclusionsNot every patient with CHC-1 has the same lipid kinetics during the first month of bitherapy, and it is necessary to achieve a sustained virological response and/or a FLM to keep higher plasma levels of LDL-cholesterol during this period. Those subjects without FLM could benefit from statins.