Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1605028
Kurzvorträge
Leber und Galle
Hepatitis C – eine geheilte Erkrankung?: Donnerstag, 14 September 2017, 15:35 – 17:03, St. Petersburg/Forschungsforum 1
Georg Thieme Verlag KG Stuttgart · New York

Treatment with direct-acting antivirals for Hepatitis C infection improves vascular function

FP Schmidt
1   Zentrum für Kardiologie, Kardiologie I, Mainz, Deutschland
,
T Wenz
2   I. Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Mainz, Deutschland
,
B Schnorbus
1   Zentrum für Kardiologie, Kardiologie I, Mainz, Deutschland
,
A Grambihler
2   I. Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Mainz, Deutschland
,
JM Schattenberg
2   I. Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Mainz, Deutschland
,
MF Sprinzl
2   I. Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Mainz, Deutschland
,
T Münzel
1   Zentrum für Kardiologie, Kardiologie I, Mainz, Deutschland
,
PR Galle
2   I. Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Mainz, Deutschland
,
T Zimmermann
2   I. Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Mainz, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2017 (online)

Also available at
 

Introduction:

In recent years direct-acting antivirals (DAA) have revolutionized the treatment of chronic Hepatitis C virus (HCV) infection.

HCV is associated with increased cardiovascular mortality and also with changes at the vascular level such as increased intima media thickness. Whether antiviral treatment can have a positive effect on vascular function and reduce cardiovascular morbidity remains unknown.

Methods:

We recruited 20 patients (m:f = 11:9, mean age = 50.5 years) with chronic HCV infection before initiation of IFN- and ribavirin-free DAA therapy. Genotypes 1 and 3 were present in 10 patients each, none had cirrhosis. 10 patients were treated with the combination of Daclatasvir/Sofosbuvir, 7 patients received Sofosbuvir/Ledipasvir, 3 patients Ombitasvir, Paritaprevir, Ritonavir and Dasabuvir.

We assessed vascular function using flow-mediated-dilatation (FMD) of the brachial artery and several markers of vascular function, coagulation, inflammation and oxidative stress. Patients were assessed just before start of therapy, at 12 weeks after start of antiviral treatment and 12 weeks after end of treatment (SVR12).

Results:

All patients reached SVR12. ALT was significantly reduced from a median of 99.53 ± 55.31 to 27.89 ± 12.51 at end of therapy (p < 0.001).

Endothelial function, measured by FMD, significantly improved from 9.4 ± 5.2% to 11.5 ± 5.8% at 12 weeks and 11.9 ± 4.5% at SVR12 (p = 0.0309). We also found significant reductions for E-Selectin 68.7 ± 21.4 to 58.4 ± 21.8 ng/ml (p = 0.0086) and VCAM 1512 ± 549.4 to 1178 ± 394.6 (p = 0.0027). On the other hand we did not find significant changes for CRP and IL6 as markers of inflammation nor for PAI-1 and D-Dimer.

Conclusion:

DAA-therapy of chronic hepatitis C infection induced a significant increase in flow-mediated dilation (FMD) of the brachial artery as a measure of vascular function and reduced the expression of vascular adhesion molecules. This may explain the reduction in cardiovascular morbidity after successful therapy of chronic hepatitis C with new DAA.