Relation between LDL Cholesterol Levels and Hepatitis C Treatment Outcomes

Research increasingly shows that metabolic factors play a role in the pathogenesis of chronic hepatitis C. These include obesity and levels of blood fats including low-density lipoprotein (LDL), a form of cholesterol associated with atherosclerosis.

It has been proposed that the low-density lipoprotein receptor on host cells may also act as a receptor for hepatitis C virus (HCV). Competitive inhibition of HCV binding to this receptor by LDL cholesterol (also called beta-lipoprotein) has been demonstrated in vitro. If similar inhibition occurs in the body, an elevated serum LDL level may actually reduce the efficiency of HCV infection of hepatocytes.

Researchers from Beth Israel Medical Center and Albert Einstein College of Medicine investigated the role of baseline lipid values in influencing the outcome of hepatitis C treatment. They conducted a retrospective chart review of 99 patients (about half with genotype 1 HCV and half with genotypes 2 or 3) treated with interferon-based therapy between 1998 and 2004.

Results

The mean serum LDL level was 100. mg/dL in genotype 1 patients, compared with 110 in patients with genotypes 2 or 3.

Response rates were as follows:

   - Early virological response (EVR): 99 patients (100%);
   - End-of-treatment response (ETR): 88 patients (89%);
   - Sustained virological response (SVR): 77 patients (78%).

LDL and total cholesterol levels prior to treatment were higher in patients who achieved EVR, ETR, and SVR.

This difference remained significant independent of patient age.

A multivariate analysis controlling for genotype and age showed that the higher the total cholesterol and LDL levels prior to treatment, the greater the odds of responding to therapy.

Conclusion

The authors concluded that "having higher serum LDL and cholesterol levels before treatment may be significant prognostic indicators for treatment outcome of those with chronic hepatitis C infection, particularly in genotypes 1 and 2."

8/18/06

Reference
K Gopal, T C Johnson, S Gopal, and others. Correlation between beta-lipoprotein levels and outcome of hepatitis C treatment. Hepatology 44(2): 335-340. August 2006.