Impact of Direct Acting Antivirals therapy on metabolic profiles and adiponectin serum level in Egyptian patients with chronic hepatitis C infection
Authors: Elmeged Mohamed Lotfy Fahmy Abd , Ghaly Sameh Mohamed Fahim , Ahmed Osama Ashraf , Abohalima Ahmed Samir , Allam Ahmed Samir , Naguib Gina Gamal 
Published: October 2021

Abstract

Background and Objectives
Hepatitis C Virus (HCV) infection is a major global health challenge. Chronic hepatitis C viral infection is associated with wide metabolic disarrangements. HCV interacts with lipid metabolism leading to steatosis, causing wide adipocytokines changes and impairs glucose metabolism leading to increased prevalence of insulin resistance (IR) and type 2 diabetes. Several oral anti-HCV drugs (direct acting antivirals; DAAs) have been developed over the last several years. Now, HCV can be eliminated from the infected host within 12 weeks of DAA combination therapy. As, there is limited data on the effects of DAA therapy on metabolic profiles, lipid profile and adiponectin level. Hence, this study was carried out to evaluate the Impact of Direct Acting Antivirals therapy on metabolic profiles and adiponectin serum level in Egyptian patients with chronic hepatitis C infection.

Methods
This study was performed on 100 patients who have chronic infection with hepatitis C, patients were divided into two groups, Group I was 50 patients were treated with (Sofosbuvir/Daclatasvir/Ribavirin) for 3 months. Group II was 50 patients were treated with (Ombitasvir, Paritaprevir, Ritonavir/Ribavirin) for 3 months. With follow up changes were occurred in Fasting Lipid profile (total cholesterol, triglyceride, HDL and LDL), metabolic profile (fasting blood sugar, Fasting Insulin, HOMA-IR and HBA1C) and Serum adiponectin level before and after end of treatment.

Results
One hundred patients met inclusion criteria were reviewed, (56%) were males in group I while (46%) were males in group I, Mean age in group I was 47.4 ± 5.3 years while in group II was 43.2 ± 6.6 years, statistical analysis of data showed significant difference in the lipid profile in group I before and after treatment .As, we found significant reduction in serum triglycerides after treatment (113.2 ± 22.9 mg/dL vs 105.6 ± 23.2 mg/dL, P &lt; 0.001) and a significant elevation of serum Total Cholesterol, LDL and HDL after treatment (TC: 153.2 ± 20.1 mg/dL vs 174.1 ± 19 mg/dL, P &lt; 0.001, LDL: 74.7 ± 9.9 mg/dL vs 93.3 ± 12 mg/dL, P &lt; 0.001, HDL: 54.6 ± 10.1 mg/dL vs 57.2 ± 10.3 mg/dL, P 0.010) But in group II there was no significant difference in the lipid profile before and after treatment, Also, We found significant reduction in fasting insulin, HOMAIR and HBA1C after treatment in group I (Fasting Insulin: 11.4 ± 3.3 (uU/L)/ml vs 9.7 ± 2.2 (uU/L)/ml, P &lt; 0.001, HOMA-IR: 2.7 ± 0.9 vs 2.2 ± 0.6, P &lt; 0.001, HBA1C: 5.6 ± 0.4 vs 5.4 ± 0.3, P 0.003) But in group II there was no significant difference in fasting insulin, HOMA-IR and HBA1C before and after treatment. Also, we found that there was no significant changes in the serum adiponectin level in the both group before and after treatment.

Conclusion
Eradication of chronic hepatitis C viral infection with DAAs may affect the lipid and the metabolic profile of patients after the end of treatment according to the type of DAAs used in the treatment and according to the stage of the liver disease of patients. But not affect the serum Adiponectin level.