Interferon-free cure of chronic Hepatitis C is associated with weight gain during long-term follow-up

Abstract

Background and aim The advent of direct-acting antivirals has revolutionized treatment of chronic hepatitis C with very high cure rates and excellent tolerability compared to interferon-based hepatitis C virus (HCV) treatment. However, long-term effects of interferon-free cure of HCV infection on the metabolic condition of patients have not been investigated so far.

Methods We investigated weight development during and after antiviral treatment of hepatitis C. In a prospective single-center cohort study, interferon-free antiviral treatment was initiated in 284 patients. Each patient’s weight was monitored 1 year before the start of treatment, at baseline (BL), end of treatment (EOT), follow-up week 24 (FU24), and follow-up week 48 (FU48).

Results Weight gain after HCV cure was observed in 20 %, 33 %, and 44 % of patients at EOT, FU24, and FU48, respectively. The mean overall weight change at FU48 compared to baseline was 1.45 kg (95 % CI 0.44; 2.46, p = 0.02, compared to the pretreatment period). Multivariate regression revealed age as the only factor predicting weight change at FU48 (B − 0.107, 95 % CI, − 0.202 to − 0.011, p = 0.03), while gender, cirrhosis, diabetes mellitus, ribavirin, and body mass index had no influence. In the subgroup of patients younger than 60 years, mean weight gain at FU48 compared to baseline was 2.8 kg (95 % CI, 1.23 – 4.4). In contrast, patients 60 years and older had a mean weight change of − 0.04 kg (95 % CI, − 1.12 to 1.03, p = 0.005).

Conclusions Cure of HCV by interferon-free antiviral treatment was associated with weight gain in up to 44 % of patients during long-term follow-up. Weight gain occurred predominantly in patients younger than 60 years. The precise mechanism of weight gain remains to be elucidated.

Zusammenfassung

Hintergrund Die Zulassung direkt antiviraler Substanzen hat die Behandlung der chronischen Hepatitis C hinsichtlich sehr hoher Ausheilungsraten und exzellenter Verträglichkeit im Vergleich zu Interferon-basierten Behandlungen grundlegend verändert. Allerdings sind die langfristigen Auswirkungen der interferonfreien Hepatitis-C-Heilung auf die metabolische Situation der Patienten bisher nicht näher untersucht.

Methoden In dieser prospektiven monozentrischen Kohortenstudie wurden 284 Patienten bezüglich ihrer Gewichtsveränderung während und nach interferonfreier antiviraler Therapie einer chronischen Hepatitis C untersucht. Das Gewicht wurde 1 Jahr vor Beginn der Behandlung, zum Therapiestart (TS), Therapieende (TE) und zur Nachkontrolle nach 24 und 48 Wochen (NK24, NK48) erhoben

Ergebnisse Eine Gewichtszunahme konnte in 20 % zum TS, 33 % zur NK24 und 44 % zur NK48 beobachtet werden. Die durchschnittliche Gewichtszunahme lag zur NK48 bei 1,45 kg (95 % Konfidenzintervall 0,44; 2,46, p = 0,02 verglichen mit dem Zeitraum vor der antiviralen Behandlung). In der multivariaten Regressionsanalyse war ein niedriges Alter der einzige prädiktive Faktor für eine Gewichtszunahme zur NK48 (B – 0,107, 95 % Konfidenzintervall –0,202; – 0,011, p = 0,03) wohingegen das Geschlecht, der Zirrhosestatus, Diabetes mellitus und der Body-Mass-Index keinen Einfluss hatten. Patienten, die jünger als 60 Jahre alt waren, hatten demnach eine durchschnittliche Gewichtszunahme von 2,8 kg (95 % Konfidenzintervall 1,23;4,4 kg). Demgegenüber stand eine Gewichtsveränderung von – 0,04 kg bei Patienten mit 60 Jahren und älter (95 % Konfidenzintervall – 1,12; 1,03 kg, p = 0,005).

Schlussfolgerung Die Ausheilung einer chronischen Hepatitis C durch interferonfreie Therapien ist in der Langzeitnachbeobachtung in bis zu 44 % mit einer Gewichtszunahme assoziiert. Die Gewichtszunahme beschränkt sich überwiegend auf Patienten unter 60 Jahren. Der genaue Mechanismus der Gewichtszunahme bedarf weiterer Untersuchungen.

Schlüsselwörter

HCV - DAA - Übergewicht - Gewichtszunahme - metabolisches Syndrom

Key words

HCV - DAA - obesity - weight gain - metabolic syndrome

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