Metabolic changes in chronic hepatitis C patients receiving direct acting antivirals

Abstract

Background: Treatment of chronic hepatitis C (CHC) with direct acting antivirals (DAAS) improves the rates of sustained virological response (SVR). However, derangements with lipid profile and glycemic status have been observed. This study aimed to compare the effect of sofosbuvir/daclatasvir (SOF/DAC) versus sofosbuvir/ledipasvir (SOF/LED) regimens on metabolic status of CHC patients. Methods: An observational prospective study was conducted on a total of 140 easy-to-treat treatment-naïve genotype-4 chronic hepatitis C virus (HCV) infected Egyptian patients. Patients received either 400 mg SOF/60 mg DAC or SOF 400 mg/90 mg LED daily for 12 weeks. Patients were followed-up for 12 weeks after end-of-treatment. Total lipid profile, fasting blood sugar (FBS), and glycated hemoglobin (HbA1c) were measured at baseline, four weeks (during treatment), and 12 weeks post-treatment (24 weeks). Clinical laboratory tests and treatment side effects during the treatment period were assessed to ensure safety. Complete blood picture, liver function tests, fibrosis-4 index (FIB-4) were performed at baseline and week 12. Results: Both groups had 100% SVR. In both groups, no significant difference in body mass index was found after treatment. FIB-4 decreased significantly after treatment in the SOF/LED group. Regarding lipid profile, total cholesterol (TC) and low-density lipoproteins (LDL) were significantly increased then slightly decreased between week four and week 24 respectively in both groups with higher percentage change in the SOF/LED group. On the other hand, high-density lipoprotein (HDL) decreased throughout the follow-up period in both groups with no significant difference between two groups. Regarding glycemic status, HbA1c and FBS were significantly decreased in both groups throughout the study period with significant difference in the percentage change of HbA1c and FBS between two groups. Conclusions: SOF/LED regimen showed a significant change in lipid profile parameters more than the SOF/DAC regimen, while both regimens showed favorable outcomes in HbA1C and FBS levels.