METABOLIC EFFECTS OF ANTI-HCV DIRECT ACTING ANTIVIRALS (DAA): A RETROSPECTIVE STUDY

Aim: Our aim was to evaluate changes of glucose and lipid metabolism in patients with chronic hepatitis C after therapy with direct acting antivirals (DAA). Methods: All patients consecutively treated from January to November 2015 were considered.We recorded laboratory and clinical data at baseline and week 24 of follow-up. Frozen serum samples were used to assay apolipoprotein A1 (apoA1), B (apoB) and lipoprotein (a) [Lp(a)]. Wilcoxon test was utilized to estimate trends and logistic regression for predictors of lipid changes. We analyzed 100 patients, mostly cirrhotic (81%) and with genotype 1b (59%). Ninety three patients achieved sustained virological response (SVR) while 7 relapsed. From baseline to week 24 of follow-up, any modification of drugs, life-style and body mass index was registered. Results: Insulin and Homeostasis Model Assessment of Insulin Resistance declined (from 16.5±7.3 to 11.6±5.8 mIU/ml and from 3 to 2.7, p<0.001). Non-High Density Lipoprotein (HDL) cholesterol increased from 102±29 to 116±35 (p<0.001) and Lp(a) from 5.6±6.5 to 9.8±11.5 mg/dl (p<0.001). Rise of both Low Density Lipoprotein/HDL and apoB/apoA1 ratio was registered (from 1.79±1.10 to 2.08±1.05 and from 0.48±0.18 to 0.53±0.18 mg/dl, p<0.001). Notably, any change in lipid profile was recorded in patients with relapse. At univariate test for Lp(a) increase, male gender, advanced fibrosis and ribavirin use showed p<0.1 but at multivariate analysis only ribavirin appeared as independent predictor (OR 3.982, 95% CI 1.206-13.144, p¼0.023). Conclusions: DAA led to decrease of insulin-resistance. However, relevant pro-atherogenic lipid changes were registered in patients with SVR. Ribavirin emerged as independent predictor of Lp(a) increase.