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Total and LDL Cholesterol Climb After HCV Cure in People With HIV
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EACS 2023, October 18-21, 2023, Warsaw
Mark Mascolini
Total cholesterol and "bad" low-density lipoprotein (LDL) cholesterol rose significantly when direct-acting antivirals (DAAs) cured HCV infection in people coinfected with HIV [1]. But in this 407-person Chilean/Spanish study, Framingham cardiovascular risk score did not jump in tandem with vaulting cholesterol.
Uncontrolled HCV infection directly affects lipid metabolism, noted colleagues from Hospital del Salvador in Santiago, Chile and the University of Barcelona. Cholesterol levels typically run lower during HCV infection, but the hepatitis virus is linked to a greater risk of insulin resistance and cardiovascular disease, and DAA therapy can affect lipid profiles. The Santiago/Barcelona collaborators wondered how HCV cure with DAAs would affect lipids and cardiovascular risk in people coinfected with HIV.
This retrospective analysis involved HCV/HIV-coinfected people who achieved sustained virologic response (SVR) with DAAs. The researchers compared several variables when DAA therapy began and after 6 months of SVR: fasting total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and Framingham risk score for cardiovascular disease.
The study group consisted of 407 coinfected people averaging 49 years in age, 75% of them men. Total cholesterol climbed significantly from 165 mg/dL when DAA therapy began to 182 mg/dL at SVR month 6 (P < 0.001), while LDL cholesterol rose significantly from 96 to 110 mg/dL (P < 0.001). HDL cholesterol and triglycerides remained virtually unchanged through SVR month 6. Framingham risk score inched up nonsignificantly from 6 to 8 (P = 0.258), suggesting the jumps in total and LDL cholesterol had no impact on cardiovascular disease risk.
The researchers proposed that clinicians keep an eye on lipids and other metabolic parameters after HCV SVR to see if these short-term changes evolve and do begin to affect risk of cardiovascular disease.
Reference
1. Castelli A, De Lazzari E, Laguno M, Martinez E. Lipid changes and its impact on CV risk after hepatitis C virus eradication in HIV-HCV co-infected persons. EACS 2023, October 18-21, 2023, Warsaw. Abstract eP.B2.002.
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