Changes in cardiometabolic biomarkers 1 year after direct acting antiviral therapy for hepatitis C virus co-infection among people with HIV

OBJECTIVES: Among people with HIV with hepatitis C virus (HCV) co-infection, we examined differences in haemoglobin A1c (HbA1c), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and atherosclerotic cardiovascular disease (ASCVD) risk score at 12-months following direct acting antiviral (DAA) initiation, comparing people with HIV who initiated DAA with those who did not to explore the utility of DAAs beyond HCV elimination. METHODS: Utilizing a nested exposure-matched study of people with HIV age ≥ 18 years, on antiretroviral therapy from the NA-ACCORD and the Mass General Brigham HIV cohorts between 01/1/2014 and 12/31/2022, people with HIV with HCV co-infection were identified by detectable plasma HCV RNA. People with HIV who initiated DAA were matched 1:1 with people with HIV who did not initiate DAA. Multivariable linear regression models estimated HbA1c (N = 2374), TC (N = 3418) and ASCVD risk score (N = 488) at 12-months comparing people with HIV who initiated DAAs versus did not. RESULTS: We identified no significant difference in the mean HbA1c at 12-months comparing DAA initiators to DAA non-initiators (β: 0.00%, 95% confidence interval [CI] -0.09% to 0.08%). The mean TC at 12-months was 13 mg/dL (95% CI 11-16 mg/dL) higher in DAA initiators and largely due to increases in LDL. There was no significant difference in the mean ASCVD risk score at 12-months when comparing DAA initiators with those who did not initiate DAAs (β: 1.10, 95% CI -0.09 to 2.20). CONCLUSION: People with HIV with HCV who initiated DAA demonstrated no statistically significant difference in HbA1c or ASCVD risk score at 12-months compared to HIV/HCV co-infected persons who did no initiate DAA. However, TC and LDL levels increased 12 months following DAA treatment.