Serum lipids in European chronic HCV genotype 1 patients during and after treatment with pegylated interferon-alfa-2a and ribavirin

Aims: Chronic hepatitis C alters the host's lipid metabolism and HCV eradication may be followed by an increase of serum cholesterol to adverse levels. We therefore aimed to determine the impact of chronic hepatitis C and its treatment on circulating lipids in a large European cohort of HCV genotype 1 patients.

Methods: The serum lipid profile of 575 HCV genotype 1-infected patients was characterized before, during and after treatment with pegylated interferon-alfa-2a (180 ug/week) plus ribavirin (1000–1200mg/d) for 48 weeks within a randomized controlled clinical trial.

Results: Total baseline cholesterol levels were significantly higher in patients with sustained virologic response (SVR) compared to non-responders/relapsers (177mg/dL versus 167mg/dL, p=0.01), and elevated cholesterol levels were an independent predictor of SVR. During antiviral treatment cholesterol levels substantially decreased as a putative marker of interferon-activity, but rebounded above baseline in patients with SVR (177mg/dL to 188mg/dL, p=0.02), and to baseline in nonresponders/relapsers. Proportions of patients with cholesterol >240mg/dL at baseline and after HCV eradication were 4% and 6%, respectively. Significant Differences of triglyceride levels in patients with and without SVR were only observed at follow-up (136mg/dL and 117mg/dL, respectively, p=0.028) but not at baseline.

Conclusions: Our study reports a substantial pretreatment hypocholesterolemia in European HCV genotype 1 patients with non-response to interferon-alfa based therapy whereas higher pretreatment cholesterol levels were an independent predictor of SVR. After treatment-induced HCV eradication median cholesterol levels increased above baseline, but the proportion of patients with high-risk cholesterol levels remained relatively low.