Gut dysbiosis has been found to relieve in patients with hepatitis C virus (HCV) with or without co-infection with HIV who achieved a sustained virological response (SVR) after 12 weeks of treatment with Elbasvir/grazoprevir, especially in patients with suffer from fibrosis in the early stages, according to the results of a Thai study published in Journal of Infectious Diseases.
In this longitudinal study (ClinicalTrials.gov ID: NCT03037151) conducted at a hospital in Bangkok, Thailand, researchers evaluated the effect of direct-acting antivirals on the gut microbiota by analyzing and comparing microbial diversity and composition in 62 patients with hepatitis C virus and 24 patients with co-infection with HIV versus 20 adults. Without any infection in a control. Collection. Patients were treated with Elbasvir/grazoprevir and followed for 12 weeks for evaluation of SVR12 as determined by HCV RNA at a level of <12 IU/mL.
At baseline, there was no difference in biochemical parameters except for higher levels of aspartate aminotransferase and alanine aminotransferase between patients with HCV mono-infection and HCV/HIV-associated infection compared with those in the control group (s = .001 and s = .002 respectively). Compared with the control group, patients with co-infection with HCV and HCV/HIV together had lower indices of Chao1 and Shannon (s <.001 and s = .038, respectively). There was no difference in Simpson index between groups.
When considering the bacterial composition in essentially all patients, Lachnospiraceae And the Coriobacteriaceae were significantly lower among HCV and HCV/HIV patients, while Intestinal It was significantly lower among those in the control group. Patients with HCV/HIV co-infection were also lower packet/germs The proportion compared with those who had HCV mono infection (adjusted s = .020) and those in the control group (adjusted .). s = .008).
At 12 weeks of follow-up, SVR was achieved in 98.4% (61/62) of HCV-positive patients and 95.8% (23/24) of HCV/HIV-infected patients. Furthermore, in both treatment groups there was no difference in the indices of Chao1, Shannon, and Simpson versus the control group. Compared with stage 2, 3, and 4 fibrosis, those with stage 1 fibrosis had a better improvement in the Chao1 index (s = .013).
Bacterial composition in patients who achieved SVR12 showed a significant increase in Parabacteroid (s = .044) and subdoligranulum (s = .011) but a reduction in eubacterium (s <.001). eubacterium significantly decreased in patients with mono-HCV infection and in those with HCV/HIV co-infection (s < .001 for both). In addition, there has been a significant increase in lacnospira And the subdoligranulum Among patients with HCV/HIV co-infection (s = .014 and s = .023 respectively).
When comparing the different stages of fibrosis in patients who have received SVR, eubacterium It was found to be significantly decreased in all stages of fibrosis. Patients with stage I fibrosis have a significant increase in Phascolarctobacterium (s = .029), and patients with stage 2, 3, and 4 fibrosis had a significant increase in subdoligranulum (s = .014).
Limitations of this study included the short follow-up period and the relatively small number of individuals infected with HCV/HIV.
In the current study, “…we provide clinically significant evidence that initiating treatment early not only prevents progression of liver disease over time, but can also improve gut dysbacteriosis approaching healthy controls,” the researchers note. They added that more research is needed to see if improving the gut microbiota is associated with a reduction in the long-term complications associated with HCV.
Disclosure: Yasuhito Tanaka is currently conducting research funded by Janssen Pharmaceutical KK and has been honored by Gilead Sciences.
Chuaypen N, Jinato T, Avihingsanon A, et al. Improvement of gut diversity and composition after direct-acting antivirals in hepatitis C virus-infected patients with or without HIV co-infection.. J Infect Dis. Published online February 17, 2021. doi: 10.1093/infdis/jiab094