Real-Life Early Anthropometric, Lipid and Liver Changes after Direct-Acting Antiviral Therapy in PLWHIV with HCV Co-Infection

Treatment with interferon-free direct-acting antivirals (DAA) has become the gold standard in chronic hepatitis C virus (HCV) infection. Nevertheless, little research about the metabolic impact of achieving sustained virological response (SVR) is available in HCV/HIV co-infected patients. This research aimed to evaluate early anthropometric, lipid and liver parameters changes after achieving SVR 12 weeks after treatment (SVR12). A real-life retrospective descriptive before-after study assessed 128 DAA treatment episodes from 2015 to 2019 in HCV/HIV co-infected patients. Anthropometric parameters (weight, body mass index), lipid profile, genotype (GT) and viral load, liver data (basics laboratory necroinflammatory parameters and transient elastography (TE)) were collected before treatment with DAA (baseline), and when SVR12 was achieved. Significant increases (p < 0.01) were found in the early lipid profile, measured by LDLc (84.6 +/- 35.0 vs. 108.6 +/- 35.1 mg/dL) and total cholesterol (161.3 +/- 41.0 vs. 183.3 +/- 41.6 mg/dL). Significant changes (p < 0.05) were found in liver parameters, measured by ALT (58.2 +/- 34.0 vs. 22.0 +/- 16.0 U/L), bilirubin (0.8 +/- 0.6 vs. 0.6 +/- 0.5 mg/dL), albumin (4.2 +/- 0.4 vs. 4.3 +/- 0.3 g/dL) and liver stiffness (LS) (13.7 +/- 13.3 vs. 11.8 +/- 12.1 kPa). The main conclusions were that the use of DAA has an early negative impact on lipid metabolism. Achieving SVR12 against HCV leads to an early improvement in liver function and LS in HCV/HIV co-infected patients without interference with antiretroviral treatment (ART) and DAA. Short-term close lipid monitoring may be necessary when combining protease inhibitors. HCV-GT-3/HIV co-infected patients might require further close monitoring for residual fibrosis. These findings can be relevant for actual clinical practice.

Automated summary

DAAs treatment has early negative impact on lipid metabolism, while achieving SVR12 against HCV leads to early improvement in liver function and LS in HCV/HIV co-infected patients without interference with ART and DAAs.