Effects of direct‐acting antiviral agents on lipid and glucose profile in HCV patients with type 2 diabetes: A real‐life Italian experience

Abstract

Hepatitis C virus (HCV) infection is associated with an increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The impact of HCV eradication on the metabolic profile in diabetic patients treated with direct-acting antiviral agents (DAAs) is not well defined. The aim of our study was to evaluate the effects of DAAs on a lipid and glucose profile in a cohort of diabetic patients with different liver fibrotic stages.Methods: T2DM patients with active HCV infection were consecutively enrolled in this prospective trial. Glycolipidic status was assessed, before starting DAA treatment (T0) and at 12 months after the beginning of treatment (T1). Liver fibrotic stage was assessed by FibroScan.Results: In all, 131 patients were enrolled and all of them achieved a sustained virologic response. At baseline, no significant differences were found in lipid and glucose profiles in subgroup analysis by liver fibrosis, HCV genotype, and cardiovascular risk factors. At T1, total cholesterol and low-density lipoprotein cholesterol, but not triglycerides, significantly increased irrespective of liver fibrotic stage and baseline anthropometric and clinical profiles, while glycated hemoglobin significantly decreased only in F4 patients.Conclusions: HCV eradication in diabetic patients is associated with a worsening lipid profile that could impact future cardiovascular risk. A careful global monitoring of cardiovascular risk factors in all diabetic patients after HCV eradication is needed.

Effect of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, and associated metabolic comorbidities: A systematic review

“…Despite the evidence, it is noteworthy that three studies did not observe an association between lipid changes after SVR and fibrosis stage 40,61,68 . Furthermore, diabetic patients experienced an increase in TC and LDL after SVR, irrespective of fibrosis stage 73 …”

“…Baseline insulin and HOMA‐IR were greater in cirrhotic patients compared to noncirrhotic ones 28,54 . After SVR, cirrhotic patients showed a significant reduction in IR, fasting glucose, 21,52,61,72 HbA1c, 62,73 and 2‐h plasma glucose 74 . The amelioration of glycemic parameters in cirrhotic patients seems to be irrespective of BMI and the presence of T2DM, 74 but after SVR, they showed higher HOMA‐IR values compared to patients without baseline advanced fibrosis 58 .…”

“…Concerning HDL, 17 studies did not show a significant change after SVR, 20 studies observed an increase in HDL after SVR, especially in female patients with metabolic syndrome, 22,45,64,72,95 but not during the treatment when HDL declined, 13,91,96 and only 2 studies revealed a reduction in HDL 61,91 . Finally, 19 studies did not show significant changes in TGs after viral eradication, 13,22,26,40,45,46,53,60,73,74,97–103 in 16 TGs worsened, 12,16,28,36,37,39,52,58,61,64,68,72,91,92,104,105 and in 9 studies TGs decreased after SVR 38,43,54–56,69,79,106,107 …”

Effects of HCV Clearance with Direct-Acting Antivirals (DAAs) on Liver Stiffness, Liver Fibrosis Stage and Metabolic/Cellular Parameters

“…Much evidence points to the profound impact of HCV infection on lipid metabolism, even in the presence of other comorbidities like type II diabetes mellitus (T2DM) [ 38 ].…”