Hepatitis C Virus (HCV) Treatment With Directly Acting Agents Reduces the Risk of Incident Diabetes: Results From Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES)

Butt, Adeel A.; Yan, Peng; Aslam, Samia; Shaikh, Obaid S.; Abou‐Samra, Abdul‐Badi

doi:10.1093/cid/ciz304

Cited by 32 publications

(45 citation statements)

References 32 publications

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“… 34 Recent data have suggested that successful treatment with DAAs improves glycaemia and reduces incidence of T2DM. 35 36 However, serum cholesterol and low-density lipoprotein levels may increase post-treatment, 36 emphasising the importance of assessing individual CV risk. It is not clear from our study why rates of prescribing drugs for primary prevention of CV risk were low in this cohort.…”

Section: Discussionmentioning

confidence: 99%

Increased cardiovascular risk and reduced quality of life are highly prevalent among individuals with hepatitis C

McPherson¹,

Gosrani

Hogg

et al. 2020

BMJ Open Gastroenterol

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ObjectiveHepatitis C virus (HCV) infection is common. Although treatment is effective, with oral antivirals curing >95% of patients, most individuals have comorbidities that persist long term. Therefore, our aim was to determine the prevalence of potentially modifiable health problems in patients with HCV and develop an HCV care bundle to identify and target comorbidities.DesignCross-sectional, observational single-centre study that recruited consecutive patients with HCV from our viral hepatitis clinics. Data were collected on cardiovascular (CV) risk factors, lifestyle behaviours, anthropometry and health-related quality of life (HRQoL). QRISK 3 was used to predict 10-year CV event risk.Results100 patients were recruited (67% male, 93% white, median age 52 years (range 24–80); 71% were treated for HCV; 34% had cirrhosis; 14% had diabetes; 61% had hypertension; 31% had metabolic syndrome; and 54% were smokers). The median 10-year CV event risk was 8.3% (range 0.3%–63%). 45% had a predicted 10-year CV event risk of >10%. Only 10% of individuals were treated with statins and 27% with antihypertensives. 92% had a predicted ‘heart age’ greater than their chronological age (median difference +7 (−4 to +26) years). HRQoL was reduced in all SF36v2 domains in the cohort. Factors independently associated with HRQoL included cirrhosis, metabolic syndrome, history of mental health disorder, sedentary behaviour and HCV viraemia.ConclusionA large proportion of patients with HCV presented with increased risk of CV events, and rates of smoking and sedentary behaviour were high, while prescribing of primary prophylaxis was infrequent. HRQoL was also reduced in the cohort. A ‘care bundle’ was developed to provide a structured approach to treating potentially modifiable health problems.

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Section: Discussionmentioning

confidence: 99%

Increased cardiovascular risk and reduced quality of life are highly prevalent among individuals with hepatitis C

McPherson¹,

Gosrani

Hogg

et al. 2020

BMJ Open Gastroenterol

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“…Regarding the impact of DAAs on the incidence of DM (Table 2), recent studies performed on large series of patients of the US Veterans Administration reported conflicting data; in the study of Butt and colleagues [43], 21279 diabetic patients treated with DAAs and 4764 nondiabetic patients treated with pegylated interferon (PEG-IFN)/ribavirin (RBV) were included, as well as a control group composed of untreated nondiabetic patients. The incidence of DM was recorded, although without providing the follow-up data, in the various subgroups and a significant reduction of DM onset was observed in patients treated with DAAs (9.89/1000 person-years, 95% confidence interval (CI) 8.7-11.1) compared to untreated patients (20.6, 95% CI 19.6-21.6, p < 0.001) and those treated with PEG-IFN/RBV (19.8, 95% CI 18.3-21.4), p < 0.001).…”

Section: Does Svr Achieved By Daas Significantly Prevent the Onset Ofmentioning

confidence: 99%

The Effect of Viral Clearance Achieved by Direct-Acting Antiviral Agents on Hepatitis C Virus Positive Patients with Type 2 Diabetes Mellitus: A Word of Caution after the Initial Enthusiasm

Ribaldone

Sacco

Saracco

2020

JCM

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The causal link between chronic hepatitis C and glycometabolic alterations has been confirmed by much biochemical, clinical, and epidemiological research work, but what is still controversial is the long-term clinical impact of sustained virologic response (SVR) achieved by direct-acting antiviral agents (DAAs) on patients with type 2 diabetes mellitus (DM). The aim of this paper is to summarize the biochemical and clinical consequences to DM of DAA-based therapy for hepatitis C virus (HCV) infection. An electronic search of Embase, PubMed, MEDLINE, Ovid, and the Cochrane Database of Systematic Reviews was conducted for publications assessing whether clearance of HCV achieved by interferon (IFN)-free antiviral therapy determines significant changes in glycometabolic control and clinical outcomes of diabetic patients. A beneficial effect of SVR obtained by DAA therapy on DM prevention and the short-term outcome of glycometabolic alterations are acknowledged by most of the studies. Whether this effect is maintained over the long term with a significant clinical impact on diabetic and liver disease is still a matter of debate.

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“…Multivariable logistic regression analysis was used to generate odds ratios and 95% confidence intervals for factors associated with attainment of SVR. Variables were included based on their known association with HCV virologic response and our previous published studies that have used similar variables (Butt et al, 2019a;Butt et al, 2019b;Butt et al, 2019c).…”

Section: Discussionmentioning

confidence: 99%

“…We used the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) for the current study. ERCHIVES has been detailed in numerous previous publications (Butt et al, 2019a;Butt et al, 2019b;Butt et al, 2019c). Briefly, all Veterans in the Department of Veterans Affairs healthcare system (VA) who were diagnosed to have HCV based on an positive HCV antibody test are included in the cohort.…”

Section: Study Populationmentioning

confidence: 99%

Hepatitis C virologic response in hepatitis B and C coinfected persons treated with directly acting antiviral agents: Results from ERCHIVES

Butt

Yan

Aslam

et al. 2020

International Journal of Infectious Diseases

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Background: There are scant data regarding hepatitis C (HCV) virologic response to directly acting antiviral agents (DAAs) in chronic hepatitis B (HBV) and HCV coinfected persons. HCV treatment response in those with spontaneously cleared HBV infection is unknown. Methods: All HCV infected persons treated with a DAA regimen in ERCHIVES were identified and categorized into HBV/HCV-coinfected (HBsAg, HBV DNA or both positive), HCV-monoinfected, and resolved HBV (isolated HBcAb+). SVR rates were determined and compared for all groups. Logistic regression model was used to determine factors associated with SVR. Results: Among 115 HCV/HBV-coinfected, 38,570 HCV-monoinfected persons, and 13,096 persons with resolved HBV, 31.6% of HCV/HBV-coinfected, 24.6% of HCV-monoinfected and 26.4% with resolved HBV had cirrhosis at baseline. SVR was achieved in 90.4% of HCV/HBV-coinfected, 83.4% of HCV-monoinfected and 84.5% of those with resolved HBV infection (P = 0.04 HCV/HBV vs. HCV monoinfected). In a logistic regression model, those with HCV/HBV were more likely to achieve SVR compared with HCV monoinfected (OR 2.25, 95% CI 1.17, 4.31). For HCV/HBV coinfected, the SVR rates dropped numerically with increasing severity of liver fibrosis (P-value non-significant). Factors associated with a lower likelihood of attaining SVR included cirrhosis at baseline (OR 0.85, 95% CI 0.80, 0.92), diabetes (OR 0.93, 95% CI 0.87, 0.99) and higher pre-treatment HCV RNA (OR 0.86, 95% CI 0.84, 0.87). Conclusion: HBV/HCV-coinfected persons have higher overall SVR rates with newer DAA regimens. Though not statistically significant, the virologic response is graded, with decreasing SVR rates with increasing degree of liver fibrosis as determined by the FIB-4 scores.

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Hepatitis C Virus (HCV) Treatment With Directly Acting Agents Reduces the Risk of Incident Diabetes: Results From Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES)

Cited by 32 publications

References 32 publications

Increased cardiovascular risk and reduced quality of life are highly prevalent among individuals with hepatitis C

Increased cardiovascular risk and reduced quality of life are highly prevalent among individuals with hepatitis C

The Effect of Viral Clearance Achieved by Direct-Acting Antiviral Agents on Hepatitis C Virus Positive Patients with Type 2 Diabetes Mellitus: A Word of Caution after the Initial Enthusiasm

Hepatitis C virologic response in hepatitis B and C coinfected persons treated with directly acting antiviral agents: Results from ERCHIVES

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