HCV infection characteristics, treatment uptake and outcomes in patient with diabetes mellitus

Abstract

Background The interplay between HCV, DM, and DAA therapy is poorly understood. We compared HCV infection characteristics, treatment uptake, and treatment outcomes in patients with and without DM. Methods A retrospective cohort study was conducted using data from The Ottawa Hospital Viral Hepatitis Program. Statistical comparisons between diabetes and non-diabetes were made using χ2 and t-tests. Logistic regression analyses were performed to assess predictors of DM and SVR. Results One thousand five hundred eighty-eight HCV patients were included in this analysis; 9.6% had DM. Patients with DM were older and more likely to have cirrhosis. HCC and chronic renal disease were more prevalent in the DM group. Treatment uptake and SVR were comparable between groups. Regression analysis revealed that age and employment were associated with achieving SVR. Post-SVR HCC was higher in DM group. Conclusion The high prevalence of DM in our HCV cohort supports screening. Further assessment is required to determine if targeted, early DAA treatment reduces DM onset, progression to cirrhosis and HCC risk. Further studies are needed to determine if optimization of glycemic control in this population can lead to improved liver outcomes.

Effects of comorbid conditions and prescribed chronic medications on the treatment plan for chronic hepatitis C infection: A cross‐sectional retrospective study

“…Achieving SVR is equally possible in both diabetic and nondiabetic patients. 42 However, T2D accelerates the progression of CHC and increases the risk of extrahepatic complications such as nephropathy and ischemic stroke. 43 Several studies have examined the complex association between comorbid conditions and CHC clearance and progression.…”

“…It is not yet known if the presence of diabetes impacts the clearance of HCV. Achieving SVR is equally possible in both diabetic and nondiabetic patients 42 . However, T2D accelerates the progression of CHC and increases the risk of extrahepatic complications such as nephropathy and ischemic stroke 43 …”

Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals

“…HCV infection is associated with diabetes in 5.9–43.2% of patients [ 59 , 60 , 61 ]. HCV induces insulin resistance through various pathogenic processes: oxidative stress, production of inflammatory cytokines, pancreatic ß-cell dysfunction, direct inhibition of insulin signaling [ 62 ]. Historically, diabetes and insulin resistance were considered negative predictors of a response to interferon-based HCV treatment [ 63 , 64 ].…”

“…Historically, diabetes and insulin resistance were considered negative predictors of a response to interferon-based HCV treatment [ 63 , 64 ]. On the contrary, DAAs appear to be as effective in diabetic as in non-diabetic patients [ 62 ]. Viral eradication appears to improve the metabolism of glucose, even in patients with cirrhosis [ 65 , 66 ].…”

“…Viral eradication appears to improve the metabolism of glucose, even in patients with cirrhosis [ 65 , 66 ]. Diabetic patients are more at risk of developing HCC after SVR, probably due to concurrent metabolic steatohepatitis or reduced immune surveillance against tumor cells [ 62 , 67 ].…”