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HCV cure and the long road to recovery

Chronic hepatitis C virus infection (HCV) results in abnormalities in the way the body processes cholesterol and how it regulates blood sugar levels. HCV also causes inflammation within the liver.

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Researchers at the University of Maryland in Baltimore have been monitoring participants infected with HCV or co-infected with HCV and HIV for several years, both before, during and after their treatment with direct-acting antivirals (DAAs) for HCV and subsequent cure of this virus. For many participants, blood tests did not immediately normalize after cure but took several years to do so.

Study details

The distribution of viral infections among participants in this study was as follows:

  • HCV alone – 194 people
  • HCV and HIV – 75 people

The average profile of participants upon entering the study was as follows:

  • 57 years
  • 67% men, 37% women
  • most (93%) did not have severe scarring of the liver (cirrhosis)

Participants were monitored for up to four years after being cured.

We now focus on the trends in certain blood tests, particularly those concerning fatty substances, over time.

Results

LDL-C (“bad” cholesterol)

Levels of LDL-C in the blood were low prior to treatment. Initiating DAA therapy was associated with a significant increase in LDL-C levels. However, a year after achieving cure, LDL-C levels began to decrease. By the fourth year after cure, LDL-C levels had decreased significantly, and in some cases approached the low levels seen prior to treatment. No significant changes occurred in levels of “good” cholesterol (HDL-C) during the study.

Triglycerides

Prior to DAA therapy, levels of triglycerides in the blood were significantly elevated. Upon initiating DAA therapy, triglyceride levels fell modestly. However, four years after cure, triglyceride levels became relatively low.

Liver enzymes

Levels of the liver enzymes AST (aspartate aminotransferase) and ALT (alanine transaminase) are usually elevated in people with chronic HCV infection. This elevation occurs because of ongoing inflammation and injury to the liver. However, after initiation of DAA therapy, levels of these liver enzymes in the blood fell significantly and stayed relatively low. This change provides evidence that the livers of participants in this study are recovering.

Average blood sugar levels

The average red blood cell lives for about four months. During this time, sugar binds to a protein in the red blood cell, and, when measured, this protein can reveal the average blood sugar level over the past four months. To get an idea of the average blood sugar level over the previous four months, a blood test measures the level of sugar that is bound to a protein called hemoglobin A1c (HbA1c). In the present study there were no apparent effects of DAAs on HbA1c.

Putting it all together

Taken together, the results of the Baltimore research show that changes in lipids and liver enzyme levels can occur as soon as DAA therapy is initiated. Over time, these measurements show a trend to improvement and, in many cases, normalization. People co-infected with HCV and HIV also had similar trends in the blood tests mentioned.

—Sean R. Hosein

REFERENCE:

Emmanuel B, Stafford KA, Magder LS, et al. Sustained virologic response leading to improved long-term metabolic and inflammatory outcomes. International Liver Congress, 11-15 April 2018, Paris, France. Poster FRI-390.