Statins after treatment

[northfork]

Hi everyone.

 Had my fasting lipids done, along with liver enzymes. Liver enzymes still good, but LDL , VLDL and triglycerides are through the roof. Dr wants to put me on atorvastatin.

I have some plaque in my LAD, so I guess I see why, but is this OK after treatment?

[Lynn K]

If you were not F3 fibrosis or F4 cirrhosis before treatment the AASLD says you can go back to living your life as though you were never infected.

So simply put if you did not have signifigant liver damage I would not expect it would be an issue to treat any other medical condition you develop later in life. If you do have serious liver disease then any medication should be checked for an ok with your hepatologist.

Of course the best person to ask your question would be your doctor.

[northfork]

My hepatologist and my GI doc have both retired as of June. Can you believe that?
I was F-2, and this will be only 10 mg, so I guess I'll try it.

[Lynn K]

Good luck I am sure it should not be an issue but have you discussed your concerns with the doctor who wants to prescribe this new med?

But as I said the AASLD does say those with less that F3 after treatment only need to be followed the same as a person who never had hep c.

How were you diagnosed as F2? Fibroscan and Fibrosure are not as accurate inthe mid ranges of damage so you may not even be F2 might be F1.

With less damage you have an excellent chance for your liver to heal and return to a less damaged condition.

Anyway best of luck

[northfork]

I had fibroscan and fibrosure before starting the Polaris 1 study. I had 2 liver biopsies , 2006 and 2012. The first was F1.. the second F2. The doctor who is prescribing this was not eager to address my concerns. Basically said it was her recommendation, but I don't have to do it. Well, yeah, I know that. It is low dosage with blood work in 3 months. So tired of blood work after 60 weeks (total) of DAAs and 36 weeks of placebos, but what are you gonna do? Rather not have a heart attack at this point. I have tried the diet and exercise route when I had Hep C. Lots of oat bran and even red yeast rice, but made only a 10 point difference. Now My numbers are way higher.

Thanks for your help!

[dragonslayer]

Northfork, what kind and how much exercise did you do?  I lowered my total cholesterol by about 30 points and also normalized the whole lipid profile by adding oats to the diet, and hitting the gym hard and often.

[northfork]

Dragonslayer, there was one time I did get a drop like that, but even that put me at borderline high. Now I need to shave 30 points off my VLDL. That was a shocker since it has always been around 25. Hard to get that number down, but it is way up now. I hike and cross country ski depending on the season, but hitting the gym hard and often at age 67 is not my thing. I will step up the oat bran again back to a quarter cup a day and do my best to drop 10 lbs.   

[northfork]

And I have read that these antivirals can jack up the cholesterol and triglycerides. Don't know if the effects are long lasting, though.

[Lynn K]

Had not seen that. Can you find a link for that?

[northfork]

http://www.medscape.com/viewarticle/573046_3

[northfork]

Effect of Antiviral Therapy for HCV on Lipid Levels
S Mauss et al.  Antivir Ther 21 (1), 81-88. 2016 Sep 29.  more
BACKGROUND: HCV has complex interactions with human lipid metabolism leading to down regulation of cholesterol levels. Interferon (IFN) therapy has been shown to decrease cholesterol even further. With the availability of second-generation direct-acting antiviral agents (DAA) the effect of suppressing and eliminating HCV on lipid metabolism warrants reevaluation.
METHODS: Prospective German multicentre cohort on HCV- and HIV-HCV-infected patients treated with direct-antiviral agents (GECCO). Lipids were assessed at baseline, during and after therapy. Wilcoxon test corrected for multiple testing was used.
RESULTS: For the analysis, 520 patients with chronic hepatitis C were available. Patients with chronic hepatitis C were treated as follows: sofosbuvir (SOF)/pegylated IFN (PEG-IFN)/ribavirin (RBV; HCV=34, HIV-HCV=36), SOF/RBV (HCV=47, HIV-HCV=16), SOF/simeprevir (HCV=9, HCV-HIV=2), SOF/daclatasvir +/- RBV (HCV=27, HIV-HCV=47), SOF/ledipasvir +/- RBV (HCV=147, HCV-HIV=100) and ombitasvir/paritaprevir/ritonavir +/- dasabuvir +/- RBV (2D, HCV=2, HCV-HIV=6; 3D, HCV=39, HCV-HIV=8). On treatment there was a statistically significant increase in total cholesterol for any IFN-free DAA regimen, which was maintained after end of therapy. Changes of total cholesterol were driven by changes in low-density lipoprotein cholesterol, whereas high-density lipoprotein cholesterol remained unchanged. In contrast, total cholesterol decreased on SOF/PEG-IFN/RBV and increased after end of therapy above baseline levels. Triglycerides increased during treatment with SOF/PEG-IFN/RBV, but not on DAA-only regimens.
CONCLUSIONS: Suppressing and eliminating HCV with IFN-free DAA regimens increased cholesterol levels, but had no effect on triglycerides. In contrast IFN-based therapy decreased cholesterol and increased triglycerides during treatment and led to increases in cholesterol after achieving sustained virological response.

[dragonslayer]

Interesting.. But my lipid profile was good after Harvoni treatment, so the results  in the findings are far from ubiquitous.

[Lynn K]

I do remember being told that while my cholesterol was previously low that having hep c virus and liver disease can cause suppression of cholesterol numbers. I got the sense from the link that it was more related to the eridication of the virus causing the rise.

Also didnt it say that LDL was being increased and not HLD isn't LDL the "good" cholesterol?

Thanks for finding the link very interesting.

[gnatcatcher]

LDL is the bad cholesterol. HDL is the good. My LDL rose 20 points while on Harvoni, then went back down 21 points. A year later, it was in between those extremes. My HDL rose during tx, then rose some more after tx, and now is slightly lower than during tx. My triglycerides went down 20 points while on Harvoni, then went up 3 points, and are now up another 24 points. All of these numbers are normal except that the LDL while on Harvoni had gone from "Optimal" to "Near Optimal."

I wonder how people were monitored for dietary consistency. Peanut butter that is nothing but peanuts will yield better cholesterol numbers than brand-name peanut butters that contain other ingredients. Cinnamon can lower cholesterol, but how much constitutes a serving? Saigon cinnamon is far more potent than Indonesia (a.k.a. Korintje or Padang cinnamon), which is more potent than Cassia (a.k.a. Chinese) cinnamon, which is more potent than Ceylon (a.k.a. Mexican) cinnamon. I know in my case dietary choices greatly affect all 4 of my cholesterol numbers.

[northfork]

My cardiologists Physician Assistant days they see it all the time in patients with HIV that are on protease inhibitors.

[northfork]

And keep in mind my exposure to these drugs ..asunaprevir,daclatasvir, Harvoni, Vosevi was much longer than most of you.

[Lynn K]

Yep my bad on LDL vs HDL oops not my area apparently.

As I mentioned my colesterol had been very low for years they have climbed a bit recently but so have my waistline and pants size so I suspect that is a greater influence at least for me.

I did treat a lot also a total between three interferon based tx of 18 months of interferon, 12 weeks of Sovaldi and Olysio then my last treatment of 24 weeks of Harvoni with 15 weeks of ribavirin so right there with you on that one.

Plus I have the effect of advanced liver disease so with all that combined kind of hard to say what is causing my changes in cholesterol  and anyway mine when last checked are still normal at least in theory.

Cheers to all

[northfork]

Well at least we are free of Hep C. That was the prize. 

[Lynn K]

Amen to that!