Editorial: Clinical Impact of Lipid Profile Change After DAA Treatment in CHC Patients—Authors' Reply

We wish to thank Dr. Cho for the kind summary and comments on our study ‘Clearance of Hepatitis C Viremia During Direct-Acting Antiviral Therapy Leads to Rapid Changes in Lipid and Lipoprotein Metabolism’ [1, 2]. We would like to highlight that the key and novel finding was that changes in lipid and lipoprotein levels occur rapidly within 24 h of initiating direct acting antiviral (DAA) therapy and were strongly correlated with decline in hepatitis C virus (HCV) viral load. The observation that dyslipidaemia was associated with many DAA agents and regimens and hypolipidaemia was seen with acute HCV infection and hyperlipidaemia with resolution of infection further strengthens our hypothesis that the changes in lipid and lipoprotein levels are virally mediated [3, 4]. Paradoxically, the decrease in HCV viraemia was associated with an increased expression of hepatic genes associated with de novo lipogenesis, particularly sterol regulatory element-binding protein 1 (SREBP1) and transmembrane 6 superfamily member 2 (TM6SF2) [5]. This interesting finding has been observed in other studies and requires further in vitro investigation. The dyslipidaemia associated with HCV clearance was associated with an increase in short-term cardiovascular risk using the Atherosclerotic Cardiovascular Disease (ASCVD) and Framingham risk scores. Although the outcome of HCV clearance on long-term cardiovascular risk remains unsettled the results of this and other studies suggest an increased cardiovascular risk [6, 7]. Therefore, we suggest that patients who have recovered from chronic HCV infection should be monitored for long-term cardiovascular outcomes. Those with persistent dyslipidaemia should be considered for risk lowering strategies. The effect of HCV eradication on long-term cardiovascular outcomes is currently being evaluated in a prospective 10-year follow-up study. Zahra Sarrafan-Chaharsoughi: writing – original draft, writing – review and editing. Marc G. Ghany: writing – original draft, writing – review and editing, supervision. The authors' declarations of personal and financial interests are unchanged from those in the original article [2]. This article is linked to Sarrafan-Chaharsoughi et al. papers. To view this article, visit https://doi.org/10.1111/apt.70130 and https://doi.org/10.1111/apt.70155. The data that support the findings of this study are available from the corresponding author upon reasonable request.