Lipid metabolism in patients with chronic hepatitis C, non-alcoholic fatty liver disease and obesity under the influence of treatment

Abstract

Background. In patients with advanced stages of liver fibrosis, progression of liver fibrosis and obesity may be observed after complete elimination of hepatitis C virus. The aim of the research was to study the impact of antiviral therapy on lipid metabolism indicators in patients with chronic hepatitis C (CHC) combined with non-alcoholic fatty liver disease (NAFLD). Materials and methods. Eighty-two patients were under observation, 56 with CHC combined with NAFLD and 26 with CHC. They were divided into three groups: first one (n = 23) — patients with CHC with NAFLD and obesity, second (n = 33) — participants with CHC, NAFLD and overweight, third group (n = 26) — CHC patients with normal body weight. All patients underwent determination of blood lipid spectrum and cytokines Ang-2, TGF-β1, TNF-α and neopterin, IL-6. The degree of liver fibrosis and steatosis was determined using FibroMax. Patients received sofosbuvir 400 mg, daclatasvir 60 mg once a day for 12 weeks. Results. The study found that 8 patients had liver fibrosis F3–4, 11 people — F2–3, 23 — F1–2, and 37 people — F0–1. Sustained virological response was achieved in 95.1 % of patients with CHC. No response was received in 4.9 % of patients who had advanced stages of liver fibrosis and obesity or increased body weight. After the treatment, a slight increase in the level of high-density lipoprotein cholesterol was registered in 61.1 % of patients in group 3, 50 % in group 2, and only in 31.2 % of patients in group 1. Content of total cholesterol tended to increase in patients of groups 1 and 2 and remained unchanged in group 3. Although the changes in the levels of low- and very low-density lipoprotein were statistically significant, they were not large in terms of absolute values. In 62.5 % of CHC patients with concomitant NAFLD who had obesity or increased body weight and F3–4 fibrosis, even after complete elimination of the virus, the levels of Ang-2 and TGF-β1 remain high and positively correlate with the degree of steatosis and the stage of liver fibrosis. Conclusions. After the successful elimination of the hepatitis C virus, lipid metabolism disorders are registered in patients with concomitant non-alcoholic fatty liver disease, F3–4 fibrosis and increased body weight