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Inflammation, gut dysbiosis persist despite SVR after HCV therapy

BARCELONA — In a study presented at International Liver Congress, patients treated for hepatitis C virus infection and cirrhosis, and achieved sustained virologic response still had evidence of inflammation and gut dysbiosis, suggesting that successful HCV eradication does not necessarily lead to improved gut parameters.

“In a sense we wanted to find out — since there is a huge amount of patients with cirrhosis now being treated with direct-acting antiviral agents — to see if this impacts the patients’ ability to lower systematic inflammation, which we believe in part originates in cirrhosis through gut microbiota. This might be relevant in predicting which patients need ongoing monitoring for cirrhosis-associated complications,” Jasmohan S. Bajaj, MD, associate professor of gastroenterology, hepatology and nutrition at Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, told Healio.com/Hepatology. “We found these patients who achieved SVR were statistically similar to those who did not in terms of MELD score and disease severity.”

Jasmohan S. Bajaj

Bajaj and colleagues collected and evaluated stool samples via multi-tagged sequencing of 105 patients treated for HCV with compensated cirrhosis. Serum inflammatory cytokines and endotoxemia were studied in the patients who achieved SVR and compared with patients who did not reach SVR and were still viremic.

A total of 21 patients achieved SVR a year prior to the analysis. Overall, there were no significant differences in gut microbial composition (P = .3) between the two groups or any changes in specific phyla relative abundance in firmicutes (45% vs. 48%), bacteroidetes (34% vs. 31%) or proteobacteria (5% vs. 5%). Even when specific comparisons between families were performed, no changes in relative abundances of potentially pathogenic families (Enterobacteriaceae) or potentially beneficial ones (Clostridiales XIV, Lachnospiraceae or Ruminococcaceae) were seen, according to the research.

In addition, no differences were observed between the two groups for the following cytokines: interleukin 1β (4.3±11 vs. 2.5±2 pg/mL; P = .1), tumor necrosis factor alpha (7±3 vs. 5.4±4 pg/mL; P = .5) or endotoxin (0.2±0.3 vs. 0.2±0.1 EU/mL; P = 1).

“We did not find any changes in the gut microbiota in patients who achieved SVR and of greater interest, patients did not have any changes or improvement at least, in systemic inflammation,” Bajaj said.

Baja concluded: “Investigation of treatment strategies for amelioration of this pro-inflammatory milieu should be continued despite HCV eradication.” – by Melinda Stevens

Reference:

Bajaj JS, et al. Abstract FRI-173. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.

Disclosure: The researchers report no relevant financial disclosures.