The purpose of this study was to assess the effect of hepatitis C virus (HCV) eradication with sofosbuvir based regimens on glycemic and lipid control in liver transplant patients.

This is a retrospective analysis of liver transplant patients with HCV treated and cured with a sofosbuvir containingregimen from November 2013 to August 2015. Patients with HbA1c and lipid panels within 12 months before and after therapy were identified. Medical history, demographics, HCV genotype and pre-therapy HCV RNAwere included in our analysis. Patients in whom therapy for hyperlipidemia or diabetes mellitus was alteredduring the study period were excluded.

61 patients treated for hepatitis C were screened and 23 met inclusion criteria; 65.2% were male, 39.1% were Caucasian, and 47.8% were African American. Mean age was 63.1 ± 5.4 years with a mean time from orthotopic liver transplant of 5.6 ± 4.5 years. 82.6% had a history of hypertension, and 65.2% had diabetes mellitus. 69.6% were infected with genotype 1a, and 30.4% were infected with genotype 1b. 95.7% were on tacrolimus, 4.3% were on cyclosporine, and 4.3% were also on mycophenylate. Of the 23 patients, 8 were treated with sofosbuvir/ledipasvir, 5 with sofosbuvir/ledipasvir/ribavirin, 7 with simeprevir/sofosbuvir, 1 with simeprevir/sofosbuvir/ribavirin, 1 with simeprevir/ribavirin, and 1 sofosbuvir/ribavirin/interferon. 13 patients had pre- and post-treatment measured HbA1c; which dropped from 7.0 ± 1.3 to 6.4 ± 1.1, p = 0.175. Serum LDL increased from 78.3 ± 15.9 to 108.0 ± 34.5, p < 0.001. Total cholesterol increased from 148.4 ± 23.5 to 181.5 ± 38.8, p = 0.001. There were no significant changes in HDL (p = 0.562) or triglycerides (p = 0.557) with treatment.

There is limited data regarding metabolic changes associated with HCV eradication in liver transplant patients. Our study showed significant increases in LDL and total cholesterol. Although the drop in HbA1c was not significant, it raised the question about possible improvement in glucose metabolism. HCV eradication in non-transplant patients has been associated with improvement in insulin resistances. This study suggests that physicians treating post transplant HCV patients should reassess preventive medicine measures after therapy.

CITATION INFORMATION: Morales A, Singla M, Greenwald H, Robertazzi S, Rodigas C, Washington V, Satoskar R, Smith C. Hepatitis C Eradication with Sofosbuvir Based Regimens Leads to Significant Metabolic Changes in Post Orthotopic Liver Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

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