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

Abstract 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.