Lipid Profiles After Therapy with Direct-Acting Antivirals in HCV Mono-infected and HCV/HIV Co-infected Patients

Abstract

Introduction: Chronic hepatitis C (HCV) infection is associated with significant decreases in low-density cholesterol (LDL-c) and triglycerides (TG). Potential mechanisms include interactions between lipid metabolism and HCV life-cycle, HCV-associated inflammation, or hepatic fibrosis. Limited data suggest that interferon-based HCV therapy results in increased lipid levels. It is unclear if HCV therapy with direct-acting antivirals (DAA Rx) alters lipid profiles, and, if so, whether these changes differ among HCV mono-infected (HCV) and HCV/HIV co-infected (HCV/HIV) patients and whether they correlate with hepatic fibrosis scores (FIB-4). Methods: We compared LDL-c, TG, and FIB-4 scores at baseline (BL) until 1-year after end of DAA Rx in HCV and HCV/HIV patients with sustained virologic response after DAA Rx at a Veterans Affairs Medical Center from 01/2014 until 10/2015. We analyzed changes and correlations using Wilcoxon signed rank test and Spearman's rho, respectively. Results: 118 consecutive patients were included in the analyses, 23 (19%) of whom were HIV/HCV (all on stable combination antiretroviral therapy with HIV viral loads < 100 copies/mL). Median age was 61 years, inter-quartile range (IQR): 58-65, 95% were male. Median BL HCV viral load (VL) was 6.4 log copies/mL, (IQR 6.0-6.8), 81% had HCV-genotype 1, 91% received sofosbuvir-based therapy, 86% for 12 weeks, and 31 patients took anti-hyperlipidemic therapy. Median BL FIB-4 score was significantly lower in HIV/HCV than in HCV: 2.1 (IQR 1.7-3.5) vs. 4.5, (IQR 2.9-6.4), p < 0.001 while the median BL LDL was not different: 80 mg/dL (IQR 60-107) vs. 66 mg/dL (IQR 54-81), p=0.13. BL LDL-c and BL HCV VL were inversely correlated in HCV (r=-0.28, p=0.009) but not in HIV/HCV (p=0.45). After DAA Rx, median FIB-4 scores declined more in HCV: -1.8 (IQR -0.6 to -3.3) than in HIV/HCV: -0.3 (IQR 0 to -0.6), p=0.01. Median LDL-c increased similarly: +25 mg/dL (IQR 6-36, p < 0.001) in HCV and +25mg/dL (IQR -5 to +41, p=0.003) in HIV/HCV. LDL-c and FIB-4 changes were inversely correlated (r=-0.35; p=0.046) in HCV patients only. Overall median TG declined: -20 mg/dL (IQR +10 to -45, p=0.01) with no differences between groups (p=0.95). Conclusion: Successful DAA Rx was accompanied by significant LDL-c increases regardless of HIV coinfection status. In HCV patients - in whom fibrosis scores were much higher at baseline - this was inversely correlated with FIB-4 improvements.