Lipids, glucose and iron metabolic alterations in chronic hepatitis C after viral eradication - comparison of the new direct-acting antiviral agents with the old regimens

Background: Hepatitis C virus (HCV) is a unique virus which interacts with cholesterol, iron and insulin metabolism. There is limited data on the effects of direct-acting antiviral agents (DAAs) on metabolic profiles. We aimed at evaluating the behavior of metabolic risk factors of chronically HCV-infected patients after sustained virologic response (SVR), comparing the outcomes with the new DAAs versus the old treatment regimen Peg-interferonribavirin. Methods: A total of 178 patients who achieved SVR and completed one year of follow-up were prospectively included in this study: group 1 with 105 patients treated with DAAs and group 2 with 73 patients treated with old regimens. Outcomes included lipid, glucose and iron metabolism variation after SVR. Results: There was a significant increase in total cholesterol in both groups (group 1: p<.001, 95% CI: 0.41-0.78; group 2: p<.001, 95% CI: 0.24-0.69). Triglyceride levels significantly decreased (p=.015, 95% CI: -0.33-0.04) in group 1 and increased (p=.014, 95% CI: 0.07-0.59) in group 2. LDL levels increased in group 1 (p=.029, 95% CI: 0.05-0.88), but no significant variation was found in group 2. No significant variation in HDL, fast glucose and iron was seen in both groups. There was a significant increase of HOMA (p=.002, 95% CI: 0.17592-0.72317) only in group 2. Ferritin serum levels significantly decreased (p<.001, 95% CI:-138.3-74.4) in group 1 but no significant variation was found in group 2. Conclusion: Patients who have achieved SVR may have increased risk of cardiovascular outcomes due to development of hyperlipidemia and insulin resistance.