Chronic Hepatitis C Association with Diabetes Mellitus and Cardiovascular Risk in the Era of DAA Therapy

Dražilová, Sylvia; Gazda, Jakub; Janíčko, Martin; Jarčuška, Peter

doi:10.1155/2018/6150861

Cited by 57 publications

(67 citation statements)

References 84 publications

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“…It has been recently shown that DAAs improve metabolic balance in CHC patients by exerting beneficial effects on fasting glucose, glycated haemoglobin and hypertension …”

Section: Discussionmentioning

confidence: 99%

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Direct‐acting antivirals for HCV treatment in older patients: A systematic review and meta‐analysis

Villani

Monami

Cosimo

et al. 2019

Journal of Viral Hepatitis

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The advent of highly effective and well‐tolerated direct antiviral antivirals (DAAs) has dramatically changed the landscape of chronic hepatitis C. The effect of DAAs in older adults is difficult to determine since patients aged ≥ 65 years were too few in most clinical trials and data mainly come from observational studies. We performed a systematic review and meta‐analysis to evaluate the efficacy and safety of DAAs in patients aged 65 and older. PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, HCV‐Trials.com databases were searched for literature published until 1 December 2017. English language articles reporting results of phase 2 or 3 randomized controlled trials (RCTs), single‐arm clinical trials (SATs) and observational studies were included in the final analysis. All studies included subgroups of older patients and compared their outcomes with younger individuals. By using a random‐effects or fixed‐effects model, odds ratio (OR) was calculated for the efficacy and safety. Heterogeneity was tested using I2 statistics. Thirty‐seven studies reported data on the DAA efficacy. The OR was 1.66 (95%CI: 1.00‐2.75; P = 0.06) in meta‐analysis of RCTs, and similar results were found in SATs and observational studies. HCV genotype, stage of fibrosis or HIV co‐infection did not affect the rate of SVR in older persons. Prevalence of anaemia (OR 0.26 95%CI: 0.09‐0.69; P = 0.007) (OR 0.25 95%CI: 0.09‐0.69; P = 0.007) and skin complaints (OR 0.61 95%CI: 0.45‐0.83; P = 0.001) was higher in older adults. Finally, geriatric patients affected by chronic HCV infection can be safely treated with DAAs with the same efficacy reported in younger adults.

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“…It has been recently shown that DAAs improve metabolic balance in CHC patients by exerting beneficial effects on fasting glucose, glycated haemoglobin and hypertension …”

Section: Discussionmentioning

confidence: 99%

“…These changes may result in a large number of benefits even in older ages such as reduction of polypharmacotherapy and cardiovascular risk and finally in improvement of quality of life.…”

Section: Discussionmentioning

confidence: 99%

Direct‐acting antivirals for HCV treatment in older patients: A systematic review and meta‐analysis

Villani

Monami

Cosimo

et al. 2019

Journal of Viral Hepatitis

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“…58 Hypolipidemia during viremic status can be reversed to deteriorate lipid profiles after DAA therapy. 59 An increase in the small dense low-density lipoprotein cholesterol level corresponding to increased carotid intima-media thickness 1 year after DAA therapy has been reported. 60 Attention should be paid not only to liver-related complications but also to the extrahepatic consequence of cardio-cerebrovascular disease in the post-SVR period.…”

Section: Extrahepatic Manifestationsmentioning

confidence: 98%

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

Huang

2020

Clin Mol Hepatol

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The treatment of chronic hepatitis C (CHC) has been revolutionized in an era of all-oral direct-acting antivirals (DAAs) since 2014. Satisfactory treatment efficacy and tolerability can be provided by novel DAAs. Nevertheless, there are still some unmet needs and emerging issues in the treatment of CHC in the DAA era. Certain hard-to-cure populations are prone to have inferior treatment responses, including patients with severe liver decompensation, active hepatocellular carcinoma (HCC), and hepatitis C virus (HCV) genotype 3 (HCV-3) infection and those who experience multiple DAA treatment failures. Hepatitis B virus (HBV) reactivation during and after DAA treatment has raised concern regarding the use of prophylactic antivirals against HBV throughout DAA treatment. However, the standard strategy for the use of prophylactic antivirals is not uniform across regional guidelines. In the post-sustained virological response (SVR) period, HCC still occurs in a substantial proportion of patients. Due to the relatively short follow-up period, the net benefit of the achievement of an SVR by DAAs in the reduction of extrahepatic manifestations has not yet been determined. Attention must also be paid to HCV reinfection, particularly in high-risk populations. The most critical and unmet need for HCV elimination is the large gap in the HCV care cascade at the population level. To accomplish the World Health Organization (WHO)’s goal for HCV elimination by 2030, the expansion of access to HCV care requires a continuous effort to overcome practical and political challenges.

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“…Chronic hepatitis C (CHC) virus infection is a major cause of liver cancer and cirrhosis. In addition, some studies have indicated that patients with CHC have both higher prevalence of type 2 diabetes and increased cardiovascular risk compared to those who have never been infected [1,2]. Globally, an estimated 71 million people have CHC, which is caused by the hepatitis C virus (HCV), a blood borne virus.…”

Section: Introductionmentioning

confidence: 99%

“…The World Health Organization has developed a global health strategy to eliminate hepatitis C by 2030 [4], and the Taiwanese government also launched an elimination goal by 2025 [3]. In addition, previous literature confirmed that DAA treatment is not only beneficial for HCV clearance but is also associated with better fasting glucose and controlled glycated hemoglobin levels and improved cardiovascular function [2,11].…”

Section: Introductionmentioning

confidence: 99%

An Investigation of the Side Effects, Patient Feedback, and Physiological Changes Associated with Direct-Acting Antiviral Therapy for Hepatitis C

Chang

et al. 2019

IJERPH

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Background: Hepatitis C virus (HCV) infection is one of the major causes of liver cirrhosis and hepatocellular carcinoma globally. The advent of direct-acting antivirals (DAAs) with high cure rates provides an opportunity to reduce the rising HCV disease burden. However, few studies have explored the side effects and physiological benefits of DAA therapy in rural areas. The aim of this study was to investigate the subjective reports of discomfort, patient feedback about the course of treatment, and physiological changes after DAA treatment in HCV patients. Methods: A descriptive, prospective, comparative cohort study was conducted from January to August 2019 in western coastal Yunlin County, Taiwan. Data regarding demographic characteristics, subjective discomfort levels, and physiological responses were collected through face to face interviews and from medical records by a cooperating hospital. Results: Six-hundred-and-twenty-three participants with an active HCV infection were identified; 555 (89.1%) had completed treatment, and sustained virologic response was achieved in 99.6% (n = 553). The mean age was 64.9 (standard deviation = 13.1) years, and 35% of patients experienced discomfort during DAA treatment, including fatigue, itching, and dizziness. After three months of treatment, physiological markers, including body weight (p < 0.001), waist circumference (p < 0.05), blood pressure (p < 0.001), alanine aminotransferase (p < 0.001), and aspartate aminotransferase (p < 0.001), had significantly improved. Almost all participants provided positive feedback about the treatment experience and reported manageable side effects. Conclusions: The findings showed that, in an endemic rural area, DAA treatment had a high cure rate and improved physiological markers with few discomforts. These results can be used to reduce the barriers HCV patients face in adopting new medications.

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Chronic Hepatitis C Association with Diabetes Mellitus and Cardiovascular Risk in the Era of DAA Therapy

Cited by 57 publications

References 84 publications

Direct‐acting antivirals for HCV treatment in older patients: A systematic review and meta‐analysis

Direct‐acting antivirals for HCV treatment in older patients: A systematic review and meta‐analysis

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

An Investigation of the Side Effects, Patient Feedback, and Physiological Changes Associated with Direct-Acting Antiviral Therapy for Hepatitis C

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