Highlights
- •Hepatitis C virus (HCV) causes extra-hepatic conditions such as insulin resistance (IR).
- •IR was associated with total circulating triglycerides (TG) but not with cholesterol.
- •Direct-acting antivirals (DAAs) are highly effective for the eradication of HCV.
- •HCV eradication with DAAs decreased in IR and HDL-TG after one-year follow-up.
Abstract
Background & aims
Hepatitis C virus (HCV) interferes with carbohydrate and lipid metabolism causing
cardiovascular disease and insulin resistance (IR). Direct-acting antivirals (DAAs)
are highly effective for the eradication of HCV, with positive effects on metabolic
health although paradoxically associated with increased total and LDL-cholesterol.
The aims of this study were 1) to characterize dyslipidemia (lipoprotein content,
number, and size) in naive HCV-infected individuals and 2) to evaluate the longitudinal
association of metabolic changes and lipoparticle characteristics after DAA therapy.
Methods
We conducted a prospective study with one-year follow-up. 83 naive outpatients treated
with DAAs were included. Those co-infected with HBV or HIV were excluded. IR was analyzed
using the HOMA index. Lipoproteins were studied by fast-protein liquid chromatography
(FPLC) and Nuclear Magnetic Resonance Spectroscopy (NMR).
Results
FPLC analysis showed that lipoprotein-borne HCV was only present in the VLDL region
most enriched in APOE. There was a lack of association between HOMA and total cholesterol
or cholesterol carried by LDL or HDL at baseline. Alternatively, a positive association
was found between HOMA and total circulating triglycerides (TG), as well as with TG
transported in VLDL, LDL, and HDL. HCV eradication with DAAs resulted in a strong
and significant decrease in HOMA (−22%) and HDL-TG (−18%) after one-year follow-up.
Conclusions
HCV-dependent lipid abnormalities are associated with IR and DAA therapy can reverse
this association. These findings may have potential clinical implications as the HDL-TG
trajectory may inform the evolution of glucose tolerance and IR after HCV eradication.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 16, 2023
Accepted:
May 3,
2023
Received in revised form:
May 3,
2023
Received:
January 27,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
