DAA Treatment Improves Liver Function, Increases Risk of Anemia in Patients With HCV, Study Finds

Linh Pham Van, MD, PhD

Credit: Loop

The liver function of patients with hepatitis C virus (HCV) improved while prevalence of anemia increased and fasting blood glucose level, hemoglobin A1C index, and renal function decreased after 12 weeks of treatment with direct-acting antivirals (DAA), according to findings from a recent study.

“The impact of DAA therapy on lipid and glucose metabolism and on kidney function and its side effects on blood cell count remains controversial,” wrote investigators.¹

According to the World Health Organization (WHO), DAAs can cure more than 95% of people with HCV. In their 2022 guidelines, the WHO recommended DAA therapy for all adults, adolescents, and children down to 3 years of age with chronic HCV because of its cure rate and short treatment duration.²

To assess the impact of DAA therapy on general metabolic processes, renal function, and blood cell count in patients with HCV, a team of investigators led by Linh Pham Van, MD, PhD, of Hai Phong University of Medicine and Pharmacy in Hai Phong, Vietnam, conducted an observational prospective study using data from patients with HCV who achieved SVR12 after treatment with DAA therapy without ribavirin. To be included in the study, participants were required to be aged 18 years or older, DAA-naive with HCV infection, prescribed DAAs, and achieve SVR after 12 weeks of DAA treatment.¹

Investigators screened 567 patients at the Gastroenterology and Hepatobiliary Clinic of Hai Phong International General Hospital and selected 280 patients who met inclusion criteria. Data on biochemical tests, renal function, blood counts, viral load, and host genomics were recorded before treatment and after 12 weeks of treatment with DAAs. Among the 280 patients with HCV included in the study, 25 had diabetes, 18 had hypertension, 13 had hepatitis B virus infection, 5 had gastric ulcers, and 6 had malignant cancer. In total, 32% (n = 91) of participants were male and the median age was 49 years (interquartile range 42-59).¹

Rapid virologic response was achieved in 13.22% (n = 37) of patients after treatment. The median aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 factor (FIB-4) scores before treatment were 0.67 and 2.1, respectively. Among the cohort, 46% of patients had HCV genotype 6, 45% had genotype 1, 5% had genotype 2, and 3% had genotype 3.¹

Investigators noted outcomes of interest were changes in metabolic, renal, and hematological data after 12 weeks of treatment with DAA therapy. Investigators also evaluated the relationship between clinical laboratory indicators and HCV genotypes.¹

Upon analysis, the FIB-4 score of the study group decreased from 2.09 (interquartile range [IQR], 1.26-3.55) at baseline to 1.26 (IQR, 0.89-1.90) at week 12 of treatment (1.06 ± 2.18; P < .001). Liver function improved significantly after 12 weeks of treatment, as shown by the decrease in AST and ALT levels from a median of 50.82 and 61.73 before treatment to 28.77 and 27.25 after treatment, respectively (P < .001). Investigators also noted the fasting blood glucose concentration and HbA1C index of patients with HCV infection decreased from 7.98 mmol/L to 6.29 mmol/L and from 8.14% to 6.16%, respectively (P < .001).¹

Investigators pointed out hemoglobin concentration decreased from 140.99 to 136.58 g/L and hematocrit index decreased from 0.42 g/L to 0.34 g/L after 12 weeks of treatment (P < .05). Platelet counts also decreased from 230.92 g/L at baseline to 217.7 g/L after 12 weeks (P = 0.037). Although the increase in creatinine concentration was not statistically significant, the decrease in the estimated glomerular filtration rate (eGFR) from 93.07 mL/min/1.73m2 to 80.08 mL/min/1.73m2 was significant (P < .001).¹

Of note, changes in patients’ hepatobiliary function were not related to the HCV genotype (P > .05). Investigators also pointed out changes in lipid profiles, including cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides, after treatment with DAAs did not differ among the genotypes (P > .05). Additionally, hemoglobin and hematocrit levels were reduced after DAA treatment compared to pretreatment data, although investigators noted these reductions were significantly different between genotypes (P < .05). Changes in HbA1C index after DAA treatment were also significantly different between the different genotypes (P = .041).¹

Among the 280 patients, the number of those with anemia increased from 66 before treatment to 86 after treatment (P = .047). Multivariate logistic regression analysis showed the anemia status after week 12 of treatment was dependent on sex (odds ratio [OR], 5.87; 95% confidence interval [CI], 2.87-12.83; P = .001), cirrhosis status (OR, 2.21; 95% CI, 1.98-5; P = .047); FIB-4 (OR, 1.18; 95% CI, 1.02-1.4; P = .046), baseline eGFR (OR, 0.99; 95% CI, 0.99-1; P = .004), and baseline Hb concentration (OR, 0.97; 95% CI, 0.95-0.99; P = .001) before treatment.¹

“The results of our study can help clinicians guide the treatment and prognosis of this disease and improve the effectiveness and safety of therapies for chronic HCV infection,” concluded investigators.¹

References:

1. Thi Thu PN, Hoang Van D, Ngo Thi Quynh M, et al. Metabolic, renal, and hematological changes in chronic hepatitis C patients achieving rapid virologic response after 12 weeks of direct-acting antiviral treatment: A prospective cohort study. PLoS ONE 18(9): e0290235. https://doi.org/10.1371/journal.pone.0290235
2. World Health Organization. Hepatitis C. Newsroom. Accessed September 8, 2023. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c