Excess Weight Gain After Cure of Hepatitis C Infection with Direct-Acting Antivirals

Abstract

Background: Cure from chronic hepatitis C virus (HCV) infection is readily achievable with direct-acting antivirals (DAA), but little is known about optimal management after treatment. Weight gained after DAA treatment may mitigate benefits or increase risk for liver disease progression. As the single largest sample of HCV-infected individuals receiving DAA treatment in the United States, the Veterans Affairs (VA) Birth Cohort is an ideal setting to assess weight gain after DAA treatment.

Methods: We performed a prospective study of patients dispensed DAA therapy from January 2014 to June 2015. Weight change was calculated as the difference in weight from sustained virologic response (SVR) determination to 2 years later. Demographic, weight, height, prescription, laboratory, and diagnosis code data were used for covariate definitions. We used multiple logistic regression to assess the association between candidate predictors and excess weight gain (≥ 10 lbs) after 2 years.

Results: Among 11,469 patients, 78.0% of patients were already overweight or obese at treatment initiation. Overall, SVR was achieved in 97.0% of patients. After 2 years, 52.6% of patients gained weight and 19.8% gained excess weight. In those with SVR, weight gain was as high as 38.2 lbs, with the top 10% gaining ≥ 16.5 lbs. Only 1% of those with obesity at treatment initiation normalized their weight class after 2 years. Significant predictors of post-SVR weight gain were SVR achievement, lower age, high FIB-4 score, cirrhosis, and weight class at treatment initiation.

Conclusion: Weight gain is common after DAA treatment, even among those who are overweight or obese prior to treatment. Major predictors include age, baseline weight, alcohol, cirrhosis, and SVR. Everyone receiving DAAs should be counseled against weight gain with a particular emphasis among those at higher risk.

Keywords: chronic disease; metabolic; natural history; obesity; post-SVR care.

Figure 1

Observational study design of weight gain in patients treated for chronic hepatitis C with direct-acting antivirals. DAA, direct-acting antiviral; SVR, sustained virologic response.

Figure 2

Weight change 2 years after treatment with direct-acting antivirals for chronic hepatitis C infection, by treatment outcome. Figure (but not table) excludes 229 patients with extreme values (< 1st and > 99th percentile). SVR, sustained virologic response.

Figure 3

2-year follow-up weight class, by weight class at treatment initiation. All percentages reported as percent of those in a given weight class at treatment initiation ratio. SVR, sustained virologic response.