Blood Cholesterol May Increase after Successful Hepatitis C Treatment

Blood levels of total and LDL cholesterol, which are typically lower among people with chronic hepatitis C virus (HCV) infection, may revert to dangerously high levels after successful interferon-based treatment, according to a study published in the October 2009 issue of Hepatology.

Numerous prior studies have show that people with chronic hepatitis C tend to have low levels of blood fats (hypolipidemia), though the underlying mechanisms are not fully understood. Low cholesterol and triglyceride levels are associated with decreased risk of cardiovascular disease in the general population; hepatitis C patients, however, have increased cardiovascular risk despite lower blood lipids.

In the present study, Kathleen Corey and colleagues from Massachusetts General Hospital conducted 2 linked studies to evaluated the relationship of hepatitis C and its treatment with lipid levels, and to determine the frequency of clinically significant hyperlipidemia (high blood fat levels) after completing anti-HCV therapy.

The authors first performed a case-control analysis comparing fasting total cholesterol, low-density lipoprotein (LDL or "bad cholesterol"), high-density lipoprotein (HDL or "good cholesterol), and triglyceride levels in 179 patients with hepatitis C and 180 age-matched HCV negative controls.

They then did a retrospective cohort analysis of 87 treated hepatitis C patients who had lipid data available from before and after therapy.

Results

• In the case-control analysis, the HCV infected group had significantly lower LDL and total cholesterol levels than the uninfected control group.
• In the retrospective cohort, hepatitis C patients in the treated group who achieved virological response, or HCV clearance, had larger increases in LDL and total cholesterol from baseline than patients without viral clearance.
• These results remained consistent after adjusting for patient sex, age, and HCV genotype.
• 13% of patients with virological clearance had elevated LDL levels and 33% had elevated total cholesterol levels that warranted lipid-lowering therapy.

"Hepatitis C is associated with decreased cholesterol and LDL levels," the study authors stated. "This hypolipidemia resolves with successful hepatitis C treatment but persists in non-responders."

"A significant portion of successfully treated patients experience LDL and cholesterol rebound to levels associated with increased coronary disease risk," they concluded. "We suggest that serum lipid levels should be assessed in follow-up among patients undergoing successful antiviral therapy, as clearance may reveal some patients with previously unappreciated coronary risk."

Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA; MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA.

10/09/09

Reference

KE Corey, E Kane E, C Munroe, and others. Hepatitis C virus infection and its clearance alter circulating lipids: implications for long-term follow-up. Hepatology. 50(4): 1030-1037. October 2009. Abstract.