Hepatitis C infection and clearance: impact on atherosclerosis and cardiometabolic risk factors.
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.


METHODS
Cross-sectional study.


METHODS
Egypt.


METHODS
329 chronically infected, 173 with cleared infection and 795 never infected participants aged >or=35 attended for baseline investigations. A subsample of 192, 115 and 187, respectively, underwent ultrasound.


METHODS
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.
Mostafa
Aya
A
Department of Community Medicine, Faculty of Medicine, AinShams University, Cairo, Egypt.
Mohamed
Mostafa K
MK
Saeed
Mohamed
M
Hasan
Abubakr
A
Fontanet
Arnaud
A
Godsland
Ian
I
Coady
Emma
E
Esmat
Gamal
G
El-Hoseiny
Mostafa
M
Abdul-Hamid
Mohamed
M
Hughes
Alun
A
Chaturvedi
Nish
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D050197:Atherosclerosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D001786:Blood Glucose / Q000378:metabolism; D017536:Carotid Artery, Common / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000821:virology*; D004534:Egypt / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000821:virology; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D001786:Blood Glucose; D008055:Lipids