Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 18, 2016; 8(35): 1557-1563
Published online Dec 18, 2016. doi: 10.4254/wjh.v8.i35.1557
Hepatitis C eradication with sofosbuvir leads to significant metabolic changes
Amilcar L Morales, Zachary Junga, Manish B Singla, Maria Sjogren, Dawn Torres
Amilcar L Morales, Hepatology Service, San Antonio Military Medical Center, San Antonio, TX 78234, United States
Amilcar L Morales, Zachary Junga, Maria Sjogren, Dawn Torres, Manish B Singal, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
Zachary Junga, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
Author contributions: Morales AL designed the study; Morales AL and Junga Z collected and analyzed the data, and drafted the manuscript; Singla MB performed statistical analysis and manuscript review; Sjogren M and Torres D revised the manuscript for important intellectual content, and help with development of the manuscript and study design; all authors have read and approved the final version to be published.
Institutional review board statement: The study protocol was reviewed and approved by the Walter Reed National Military Medical Center Institutional Review Board.
Informed consent statement: Informed consent was not provided by patients. The Walter Reed National Military Medical Center Institutional Review Board provided a waiver of informed consent authorizing the use of de-identified patient data for research purpose.
Conflict-of-interest statement: No potential conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Amilcar L Morales, MD, Transplant Hepatology Staff, Hepatology Service, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, San Antonio, TX 78234, United States.
Telephone: +1-210-8729581
Received: August 15, 2016
Peer-review started: August 23, 2016
First decision: September 6, 2016
Revised: September 26, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 18, 2016

To assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control.


This is a retrospective analysis of hepatitis C virus (HCV)-infected patients treated and cured with a SOF regimen [SOF/ribavirin/interferon, SOF/simeprevir, or SOF/ledipasvir (LDV) ± ribavirin] from January 2014 to March 2015. Patients with hemoglobin A1C (HbA1C) and lipid panels within six months before and six months after therapy were identified and included in our study. Due to the known hemolytic effect of ribavirin, HbA1C was obtained a minimum of three months post-treatment for the patients treated with a ribavirin regimen. Medical history, demographics, HCV genotype, pre-therapy RNA, and liver biopsies were included in our analysis. The patients who started a new medication or had an adjustment of baseline medical management for hyperlipidemia or diabetes mellitus (DM) were excluded from our analysis.


Two hundred and thirty-four patients were reviewed, of which 60 patients met inclusion criteria. Sixty-three point three percent were male, 26.7% were Caucasian, 41.7% were African American and 91.7% were infected with hepatitis C genotype 1. Mean age was 60.6 ± 6.7 years. Thirty-nine patients had HbA1C checked before and after treatment, of which 22 had the diagnosis of DM type 2. HbA1C significantly decreased with treatment of HCV (pretreatment 6.66% ± 0.95% vs post-treatment 6.14% ± 0.65%, P < 0.005). Those treated with SOF/LDV had a lower HbA1C response than those treated with other regimens (0.26% ± 0.53% vs 0.71% ± 0.83%, P = 0.070). Fifty-two patients had pre- and post-treatment lipid panels; there was a significant increase in low-density lipoprotein (LDL) and total cholesterol (TC) after treatment (LDL: 99.5 ± 28.9 mg/dL vs 128.3 ± 34.9 mg/dL, P < 0.001; TC: 171.6 ± 32.5 mg/dL vs 199.7 ± 40.0 mg/dL, P < 0.001). Pre-treatment body-mass index (BMI) did not differ from post-treatment BMI (P = 0.684).


Eradication of HCV with a SOF regimen resulted in a significant drop in HbA1C and an increase in LDL and TC post therapy.

Keywords: Hepatitis C, Sofosbuvir, Hyperlipidemia, Hemoglobin A1c, Low-density lipoprotein

Core tip: In our retrospective study, we evaluated the changes in glucose and lipid metabolism in a group of hepatitis C patients treated and cured with a sofosbuvir-containing regimen. We used hemoglobin A1c (HgA1c) and lipid panels to assess those two parameters. Six months post eradication, we found a statistically significant drop in HgA1c and an increase in low-density lipoprotein and total cholesterol. The use of HgA1c, although not perfect, is easy to understand and is frequently used by primary care doctors as a tool to assess glucose control.