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Impact of HCV eradication with direct-acting antiviral agents on serum gamma globulin levels in HCV and HCV/HIV coinfected patients

  • Laura Milazzo
    Correspondence
    Corresponding author at: III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy.
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Lorena van den Bogaart
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Salvatore Sollima
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Letizia Oreni
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Alessia Lai
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Valentina Morena
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Cecilia Bonazzetti
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Lisa Ridolfo Anna
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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  • Spinello Antinori
    Affiliations
    III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy

    Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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Published:January 21, 2020DOI:https://doi.org/10.1016/j.ejim.2020.01.006

      Highlights

      • Chronic hepatitis C may lead to hypergammaglobulinemia partly due to immune activation.
      • A rapid decrease of gamma globulins was seen after HCV eradication with antivirals.
      • HCV-RNA, ALT and fibrosis score levels were associated with gamma globulin decrease.
      • A role of HCV on B cells activation and gamma globulins production is hypothesized.

      Abstract

      Background

      chronic viral infections by both HCV and HIV may lead to polyclonal activation of B cells resulting in hypergammaglobulinemia. This study retrospectively analyzed the effect of HCV eradication with interferon-free direct-acting antiviral agents (DAAs) on the gamma globulin levels in HCV-infected patients with or without HIV coinfection to identify factors potentially associated with gamma globulins decrease.

      Methods

      The charts of patients treated with DAAs for HCV chronic infection between January 2015-June 2019 were retrospectively reviewed. Gamma globulin levels before treatment and 12 weeks after the end of anti-HCV therapy were evaluated along with liver tests, liver fibrosis stage by elastography, SVR achievement, HIV-coinfection. Multivariate analyses were carried out to assess the factors and the potential confounders related to the changes in gamma globulin levels.

      Results

      A significant decrease of gamma globulin concentration was found in both cirrhotic and non-cirrhotic HCV-infected patients after treatment (from mean ± SD of 1.5 ± 0.44 g/dL to 1.31 ± 0.37 g/dL; p = 0.0001). Adjusted linear regression analyses of serum gamma globulin changes from baseline to SVR12 showed a positive significant association with pre-treatment gamma-globulin levels (β-coefficient −0.23; p = 0.0001), Metavir fibrosis score (β-coefficient -0.74; p = 0.008), ALT values and baseline HCV-RNA levels > 800,000. No difference was found between HIV-infected and HIV-uninfected patients.

      Conclusions

      Our study confirms previous preliminary observation of the decrease of serum gamma globulins after HCV eradication either achieved with interferon-based therapy or with DAAs, suggesting a leading role of the virus on the activation of B cell compartment and gamma globulins production.

      Keywords

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