Hepatitis C eradication with direct acting antivirals leads to significant increase in serum cholesterol levels

Maria Ana Rafael


Introduction: Patients with chronic hepatitis C have low serological levels of lipoproteins, low-density lipoprotein cholesterol and total cholesterol. However, chronic hepatitis C is known to increase cardiovascular risk. Lipid dynamics after treatment with direct acting antivirals remains unclear, but an overall decrease in cardiovascular mortality is expected after hepatitis C virus clearance.

Aims and methods: In this unicentric retrospective cohort study we evaluated lipid profile behaviour after virus clearance with direct acting antivirals. 100 patients were included, excluding patients with known hypercholesterolemia or previously treated with statins. Lipid profile was assessed before, at the end-of-treatment and one year after end-of-treatment.

Results: Overall, there was a significant increase in low-density lipoprotein cholesterol (baseline 87.6 ± 37.6 mg/dL, end-of-treatment 111.1 ± 44.2 mg/dl, p-value<0.01) and total cholesterol (baseline 159.7 ± 41.7 mg/dl, end-of-treatment 187.4 ± 46.0 mg/dl, p-value<0.01) at the end-of-treatment. Changes in low-density lipoprotein cholesterol and total cholesterol from end-of-treatment to 1 year after end-of-treatment were minimal. There were no significant changes in high-density lipoprotein cholesterol and in triglycerides. The number of patients with low-density lipoprotein cholesterol > 100mg/dl almost duplicated at the end-of-treatment (32.4% to 62.3%). Potential positive predictive factors for a significant low-density lipoprotein cholesterol increase were liver cirrhosis and low baseline low-density lipoprotein cholesterol levels.

Conclusion: This study suggests that measurement of lipid profile upon completion of treatment with direct acting antivirals is essential to prevent the underdiagnosis of dyslipidemia and avoid hindering cardiovascular risk improvement after treatment.


Hepatitis C; Direct acting antivirals; Cholesterol; Low-density lipoprotein; Dyslipidemia


- Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. World Health Organization 2018

- Doyle MA, Galanakis C, Mulvihill E, et al. Hepatitis C Direct Acting Antiviral and Ribavirin Modify Lipid but not Glucose Parameters. Cells 2019; 15;8(3). DOI: 10.3390/cells8030252

- Morihara D, Ko YL, Shibata K, et al. IL28B gene polymorphism is correlated with changes in low-density lipoprotein cholesterol levels after clearance of hepatitis C virus using direct-acting antiviral treatment. J Gastroenterol Hepatol 2019; 34(11):2019-2027. DOI: 10.1111/jgh.14741.

- Lanini S, Scognamiglio P, Pisapia R, et al. Recovery of metabolic impairment in patients who cleared chronic hepatitis C infection after direct-acting antiviral therapy. Int J Antimicrob Agents 2019; 53(5):559-563. DOI: 10.1016/j.ijantimicag.2018.11.024

- Chang ML. Metabolic alterations and hepatitis C: From bench to bedside. World J Gastroenterol 2016; 28;22(4):1461-76. DOI: 10.3748/wjg.v22.i4.1461

- Petta S, Adinolfi LE, Fracanzani AL, et al. Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with severe liver fibrosis. J Hepatol 2018; 69(1):18-24. DOI: 10.1016/j.jhep.2018.02.015

- Reiner Ž, Catapano A, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias. Rev Esp Cardiol 2011; 64(12):1168.e1-1168.e60. DOI: 10.1016/j.recesp.2011.09.014

- Shiffman ML, Gunn NT. Impact of hepatitis C virus therapy on metabolism and public health. Liver Int 2017; 37(Suppl. 1):13-18. DOI: 10.1111/liv.13282

- Corey KE, Kane E, Munroe C, et al. Hepatitis C virus infection and its clearance alter circulating lipids: implications for long-term follow-up. Hepatology 2009; 50(4):1030-7. DOI: 10.1002/hep.23219

- Kawagishi N, Suda G, Nakamura A, et al. Liver steatosis and dyslipidemia after HCV eradication by direct acting antiviral agents are synergistic risks of atherosclerosis. PLoS One 2018; 21;13(12):e0209615. DOI: 10.1371/journal.pone.0209615

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