Modification of liver fibrosis, glucose and lipid profile after hepatitis C virus clearance with direct-acting antiviral agents / Cambios en la fibrosis hepática, glucosa y perfil lipídico tras la eliminación del virus de la hepatitis C con antivirales de acción directa

INTRODUCTION: There is little information on whether direct-acting antiviral (DAA) treatment can improve liver fibrosis or change glucose and lipid profile in patients with chronic hepatitis C (CHC). We aimed to evaluate the impact of sustained virologic response (SVR) on liver stiffness, glucose and lipid levels. METHODS: 445 monoinfected CHC patients started treatment with interferon-free DAA therapy from January 2015 to February 2017. Transient elastography (TE), fibrosis scores, glucose and lipid levels were analyzed at baseline and 48 weeks post-treatment (SVR48). RESULTS: The SVR rate was 97.7%. Finally, we evaluated 369 patients who achieved SVR and had reliable TE measurements. Median liver stiffness significantly decreased from 9.3 (IQR 7.3-14.3) kPa at baseline to 6.4 (IQR 4.9-8.9) at SVR48 (p < 0.0001). 54.7% of the cohort presented fibrosis regression. Median FIB4 score regressed from 2.0 (IQR 1.1-3.3) to 1.3 (IQR 0.9-2.0) (p < 0.0001). Median APRI and Forns values significantly decreased from 0.9 (IQR 0.5-1.7) to 0.3 (IQR 0.2-0.4) and from 6.2 (5.0-7.5) to 4.9 (IQR 3.8-5.9) (p < 0.001), respectively. Mean levels of total cholesterol and LDL-C increased from 172mg/dL and 101.5mg/dL to 191mg/dL and 117.5mg/dL (p < 0.0001), respectively. In the sub-group of patients with pre-diabetes or diabetes, mean glucose levels decreased from 142.7mg/dL at baseline to 127.2mg/dL at SVR48 (p < 0.001). DISCUSSION: SVR reduces liver stiffness based on TE and fibrosis scores, in patients treated with DAA. Our results show elevated total cholesterol and LDL-C and decreased glucose levels at SVR48

INTRODUCCIÓN: Se desconoce el efecto a largo plazo de los antivirales de acción directa (AAD) sobre la fibrosis hepática y el perfil metabólico en pacientes con hepatitis crónica C (HCC). Nuestro objetivo fue evaluar el impacto de la respuesta viral sostenida (RVS) sobre la rigidez hepática, la glucosa y el perfil lipídico. MÉTODOS: Un total de 445 pacientes con HCC monoinfectados iniciaron tratamiento con AAD libres de IFN entre enero del 2015 y febrero del 2017. La ET, los marcadores serológicos de fibrosis, los niveles de glucosa y lípidos se analizaron basalmente y 48 semanas tras finalizar el tratamiento (RVS48). RESULTADOS: La tasa de RVS fue del 97,7%. Finalmente analizamos 369 pacientes que obtuvieron RVS y tenían medidas fiables en la ET. La mediana de la rigidez hepática descendió de forma significativa de 9,3 (IQR 7,3-14,3) basalmente a 6,4 (IQR 4,9-8,9) kPa en RVS48 (p < 0,0001). El 54,7% de la cohorte presentó una regresión de la fibrosis. La mediana del FIB4 disminuyó de 2,0 (IQR 1,1-3,3) a 1,3 (IQR 0,9-2,0) (p < 0,0001). Las medianas del APRI y del Forns descendieron significativamente de 0,9 (IQR 0,5-1,7) a 0,3 (IQR 0,2-0,4) y de 6,2 (IQR 5,0-7,5) a 4,9 (3,8-5,9) (p < 0,001), respectivamente. La media de los niveles de colesterol total (CT) y LDL-C aumentaron de 172mg/dL y 101,5mg/dL a 191mg/dL y 117,5mg/dL (p < 0,0001), respectivamente. En el subgrupo de pacientes con prediabetes o diabetes, los niveles de glucosa descendieron de 142,7mg/dL a 127,2mg/dL en RVS48 (p < 0,001). DISCUSIÓN: La RVS reduce la rigidez hepática determinada mediante ET y marcadores serológicos de fibrosis en pacientes tratados con AAD. Nuestros resultados muestran una elevación en el CT y LDL-C y un descenso en los niveles de glucosa en RVS48

Modification of liver fibrosis, glucose and lipid profile after hepatitis C virus clearance with direct-acting antiviral agents.

INTRODUCTION: There is little information on whether direct-acting antiviral (DAA) treatment can improve liver fibrosis or change glucose and lipid profile in patients with chronic hepatitis C (CHC). We aimed to evaluate the impact of sustained virologic response (SVR) on liver stiffness, glucose and lipid levels. METHODS: 445 monoinfected CHC patients started treatment with interferon-free DAA therapy from January 2015 to February 2017. Transient elastography (TE), fibrosis scores, glucose and lipid levels were analyzed at baseline and 48 weeks post-treatment (SVR48). RESULTS: The SVR rate was 97.7%. Finally, we evaluated 369 patients who achieved SVR and had reliable TE measurements. Median liver stiffness significantly decreased from 9.3 (IQR 7.3-14.3)kPa at baseline to 6.4 (IQR 4.9-8.9) at SVR48 (p<0.0001). 54.7% of the cohort presented fibrosis regression. Median FIB4 score regressed from 2.0 (IQR 1.1-3.3) to 1.3 (IQR 0.9-2.0) (p<0.0001). Median APRI and Forns values significantly decreased from 0.9 (IQR 0.5-1.7) to 0.3 (IQR 0.2-0.4) and from 6.2 (5.0-7.5) to 4.9 (IQR 3.8-5.9) (p<0.001), respectively. Mean levels of total cholesterol and LDL-C increased from 172mg/dL and 101.5mg/dL to 191mg/dL and 117.5mg/dL (p<0.0001), respectively. In the sub-group of patients with pre-diabetes or diabetes, mean glucose levels decreased from 142.7mg/dL at baseline to 127.2mg/dL at SVR48 (p<0.001). DISCUSSION: SVR reduces liver stiffness based on TE and fibrosis scores, in patients treated with DAA. Our results show elevated total cholesterol and LDL-C and decreased glucose levels at SVR48.