Hepatitis C infection and clearance: impact on atherosclerosis and cardiometabolic risk factors
- Aya Mostafa1,
- Mostafa K Mohamed1,2,
- Mohamed Saeed3,
- Abubakr Hasan2,
- Arnaud Fontanet4,
- Ian Godsland5,
- Emma Coady6,
- Gamal Esmat2,
- Mostafa El-Hoseiny1,
- Mohamed Abdul-Hamid2,7,
- Alun Hughes6,
- Nish Chaturvedi6
- 1Department of Community Medicine, Faculty of Medicine, AinShams University, Cairo, Egypt
- 2Department of Tropical Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
- 3Viral Hepatitis Reference Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
- 4Institut Pasteur, Paris, France
- 5Department of Metabolic Medicine, Imperial College NHS Healthcare Trust, London, UK
- 6International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College NHS Healthcare Trust, London, UK
- 7Faculty of Medicine, Minia University, Minia, Egypt
- Correspondence to N Chaturvedi, International Centre for Circulatory Health, 59–61 North Wharf Road, Imperial College NHS Healthcare Trust, London W2 1LA, UK;
- Revised 12 April 2010
- Accepted 13 April 2010
- Published Online First 28 June 2010
Background Chronic hepatitis C (HCV) infection is associated with diabetes and favourable lipids.
Objective To study the effect of this paradox on atherosclerosis and cardiometabolic response to HCV clearance.
Design Cross-sectional study.
Participants 329 chronically infected, 173 with cleared infection and 795 never infected participants aged ≥35 attended for baseline investigations. A subsample of 192, 115 and 187, respectively, underwent ultrasound.
Main outcome measures Diabetes, fasting glucose, lipids and fat deposition on ultrasound. Carotid intima-media thickness (IMT) measured atherosclerosis.
Results Diabetes prevalence was raised (10.1% (95% CI 6.6 to 13.6), p=0.04) in HCV chronic, and cleared (10.1% (5.6 to 14.8), p=0.08) individuals versus 6.6% (4.9 to 8.3) in those never infected. Mesenteric fat was raised in chronic (36.4 mm (34.5 to 38.2), p=0.004), and cleared infection (37.8 (35.6 to 40.0), p<0.0001) vs never infected (32.7 (31.0 to 34.4)). LDL cholesterol was lower in chronic (2.69 mmol/l (2.53 to 2.86), p<0.001), but similar in cleared (3.56 (3.34 to 3.78), p=0.4) versus never infected (3.45 (3.30 to 3.60)). Carotid IMT did not differ by infection status: 0.73 (0.70 to 0.76, p=0.4), 0.71 (0.66 to 0.75, p=0.9), 0.71 (0.68 to 0.74), respectively. Adjustment for cardiovascular risk factors increased IMT in chronic infection (0.76 (0.72 to 0.79), p=0.02) versus never infected individuals (0.70 (0.67 to 0.73)).
Conclusions Hepatic function normalisation with HCV clearance may account for reversal of favourable lipids observed with HCV infection. Hyperglycaemia and visceral adiposity appear less amenable to HCV resolution. These different cardiovascular risk patterns may determine equivalent atherosclerosis risk by infection status. However, once these factors were accounted for, those with chronic infection had raised IMT, suggesting a direct effect of infection.
Funding This project was supported by a project grant from the Wellcome Trust (078180/Z/05/Z). Authors at Imperial College acknowledge support of the BRC.
Competing interests None.
Ethics approval This study was conducted with the approval of the University of Cairo.
Provenance and peer review Not commissioned; externally peer reviewed.