Over time evaluation of glycaemic control in direct‐acting antiviral‐treated hepatitis C virus/diabetic individuals with chronic hepatitis or with cirrhosis

Abstract

Background: Data concerning the impact of hepatitis C virus (HCV) cure on type 2 diabetes mellitus (T2DM) are controversial. The aim of the study was to evaluate the effects of anti-HCV direct-acting antiviral (DAA) treatments on long-term glucose control in HCV/T2DM patients with chronic hepatitis C (CHC) or with cirrhosis. Methods: One hundred and eighty-two consecutive HCV/T2DM patients who achieved a viral clearance by DAA treatment were enrolled. Seventy or 182 of them had CHC, and 112 had cirrhosis. Clinical, biochemical and instrumental parameters were recorded at baseline and at 48, 96 and 120 weeks (48w, 96w and 120w, respectively) after stopping DAA therapy.Results: At baseline, the overall study population had a mean of glycated haemoglobin (HbA1c) value of 7.2% (ranging from 5 to 11.2), without any significant differences between CHC and cirrhosis [7.1 and 7.2, respectively]. Evaluation over time of HbA1c variations showed a significant improvement of glucose control at all post-treatment time points compared with baseline in CHC patients (P = .001). In cirrhotic patients, a significant decrease of HbA1c levels was only found when comparing HbA1c values between baseline and 48w time-point (P = .001), whereas this improvement disappeared at both 98w and 120w (P = .8 and P = .3, respectively). Multivariate logistic regression analysis showed that patients with chronic hepatitis have a 2.5 (CI 1.066-5.945) times greater chance of achieving an improvement of glycaemic values than patients with liver cirrhosis (P = .035). Conclusion: DAA-based HCV cure induces a significant and persistent amelioration of glycaemic control in HCV/diabetic patients with chronic hepatitis, whereas cirrhotic HCV/diabetic subjects have only a transient benefit from the virus elimination.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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

“…A recent Italian study by Cacciola et al confirmed a significant reduction in HbA1c in HCV patients after treatment with DAAs that was persistent over time only in noncirrhotic subjects. 33 Nevertheless, Huang et al, in contrast with previous studies, found no changes in BMI and HbA1c, but the study was limited by a small sample size. 22 With regard to lipid profile, much evidence is consistent with a clear relationship between the HCV biologic cycle and lipoproteins metabolism.…”

“…Furthermore, no data relative to CV events were reported, not permitting speculations about a future increase in CV risk. A recent Italian study by Cacciola et al confirmed a significant reduction in HbA1c in HCV patients after treatment with DAAs that was persistent over time only in noncirrhotic subjects 33 . Nevertheless, Huang et al, in contrast with previous studies, found no changes in BMI and HbA1c, but the study was limited by a small sample size 22 .…”

Cannabis Use Is Inversely Associated with Metabolic Disorders in Hepatitis C-Infected Patients (ANRS CO22 Hepather Cohort)

“…Contrary to what was observed with interferon-based therapies, MetS does not seem to affect the sustained virologic response to treatment with direct-acting antivirals (DAA) [ 12 ]. HCV cure following DAA treatment generally leads to improvements in glucose homeostasis [ 12 , 13 , 14 ] but has no long-term impact on glucose metabolism in patients suffering from liver cirrhosis [ 14 , 15 ]. Pre-DAA diabetes increases mortality and liver-related events independently of HCV cure [ 12 ], and diabetes is also an independent risk factor of de novo hepatocellular carcinoma after DAA treatment [ 16 ].…”

Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: results from the ANRS CO22 Hepather cohort

“…Patients with chronic hepatitis C virus (HCV) infection are at greater risk of metabolic disorders such as hyperlipidemia, hepatic steatosis, insulin resistance, metabolic syndrome, and diabetes mellitus (Chaudhari et al 2021 ). Direct acting antivirals (DAA) can now cure HCV, leading to liver fibrosis regression, less liver necroinflammation, a lower risk of hepatic decompensation, amelioration of glycemic control, and lower liver-related and overall mortality (Kang et al 2021 ; Roche et al 2018 ; Huang et al 2021 ; Cacciola et al 2021 ). However, for patients with diabetes and/or cirrhosis, the benefits in terms of glycemic control and the lower risks of hepatocellular carcinoma (HCC) and mortality are not as strong (Cacciola et al 2021 ; Váncsa et al 2021 ; Benhammou et al 2021 ).…”

“…Direct acting antivirals (DAA) can now cure HCV, leading to liver fibrosis regression, less liver necroinflammation, a lower risk of hepatic decompensation, amelioration of glycemic control, and lower liver-related and overall mortality (Kang et al 2021 ; Roche et al 2018 ; Huang et al 2021 ; Cacciola et al 2021 ). However, for patients with diabetes and/or cirrhosis, the benefits in terms of glycemic control and the lower risks of hepatocellular carcinoma (HCC) and mortality are not as strong (Cacciola et al 2021 ; Váncsa et al 2021 ; Benhammou et al 2021 ). Moreover, obesity and hepatic steatosis are risk factors for HCC development after HCV cure (Minami et al 2021 ; Ji et al 2021 ).…”