A Single-arm Evaluation of the Effect of HCV Treatment on Cardiovascular Disease Risk

This study will assess the effect of treatment for hepatitis C virus (HCV) on cardiovascular disease risk. The study will enroll men and women who are infected with HCV and have underlying metabolic disease. All participants will receive a 12-week course of an HCV treatment (elbasvir/grazoprevir). Cardiovascular disease risk will be evaluated at baseline, week 4 on treatment, 12 weeks post-treatment, and 52 weeks post-treatment through noninvasive measurements of endothelial function, insulin resistance, liver fibrosis and steatosis, and circulating blood biomarkers.


Eligibility Criteria:
Inclusion Criteria:

* Men and women ≥ 18 years of age.
* Presence of HCV infection for at least 12 weeks
* Serum or plasma HCV RNA \> lower limit of quantification or detection at any time before or at the time of screening, and the absence of intervening HCV treatment
* Absence of HIV infection
* HCV treatment-naïve OR HCV treatment-experienced with PEG-IFN/RBV only (no prior HCV DAA exposure)
* Genotype 1 or 4 HCV infection. If HCV genotype 1a infection is present, absence of genotype 1a NS5A resistance associated substitutions (RASs) at amino acid positions 28, 30, 31, and 93 must be documented at screening
* Evidence of metabolic disease defined as:

  1. Insulin resistance or impaired glucose tolerance by one of the following:

     * HOMA-IR ≥2.5 at screening
     * Hemoglobin A1c 5.7-6.4% at screening
     * Diabetes mellitus with hemoglobin A1c \<7% at screening and never on more than one oral hypoglycemic agent, as well as never requiring insulin

     OR
  2. Metabolic Syndrome, defined as at least 3 of the following:

     * Waist circumference ≥102 cm for men and ≥ 88 cm for women
     * Serum triglyceride level ≥150 mg/dL or on a triglyceride lowering agent
     * Serum high-density lipoprotein (HDL) cholesterol \<40 mg/dL in men and \<50 mg/dL in women or drug treatment for low HDL cholesterol
     * Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure
     * Fasting blood glucose ≥100 mg/dL
* Ability and willingness of subject to provide written informed consent

Exclusion Criteria:

* History of decompensated liver disease (Child Pugh Class B or C)
* Albumin below 3 g/dL
* Platelet count below 75,000
* HBsAg positivity.
* Pregnancy or breastfeeding
* Inability to conform to the following drug interruptions for PAT testing, whether due to safety (determined by the investigator) or willingness: No caffeine or recreational or prescription stimulant use for 24 hours prior; no nicotine for 4 hours prior; no vigorous exercise for 12 hours prior; stopping of beta blockers, short-acting calcium channel blockers (CCBs), nitrates, angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin-receptor blockers (ARBs), and renin-inhibitors for 24 hours prior; and stopping of long acting CCBs 48 hours prior to testing.
* Use of anticoagulant or antiplatelet agents (other than aspirin ≤ 325 mg orally daily) within 1 week prior to study entry or anticipated need for these agents for \>7 days during the study follow-up period.
* Use of contraindicated concomitant medications, including OATP1B1/3 inhibitors and strong CYP3A inducers
* Serious illness including acute liver-related disease and malignancy requiring systemic treatment or hospitalization within 12 weeks prior to study entry.
* History of major organ transplantation with an existing functional graft and on immunosuppressive therapy.
* History of known vascular disorder or autoimmune processes including Crohn's disease, ulcerative colitis, severe psoriasis, rheumatoid arthritis, and cryoglobulinemia that may affect vascular studies.
* Decompensated congestive heart failure or acute cardiovascular event (such as stroke, myocardial infarction, arrhythmia, acute peripheral arterial insufficiency) within 6 months prior to study entry
* Use of immune-based therapies or systemic corticosteroids which may affect vascular studies or inflammatory/endothelial biomarkers within 12 weeks prior to study entry
* Advanced renal insufficiency as defined by glomerular filtration rate (GFR) \< 30 mL/min/1.73 m2 or treatment by dialysis
* Anticipated inability to comply with research study visits as determined by the investigator
* Poor venous access not allowing screening laboratory collection
* Having any condition that the investigator considers a contraindication to study participation