Pretreatment glucose status determines HCC development in HCV patients with mild liver disease after curative antiviral therapy

Huang, Chung‐Feng; Yeh, Ming‐Lun; Huang, Cing-Yi; Tsai, Pei‐Chien; Ko, Yu‐Min; Chen, Kuan‐Yu; Lin, Zu‐Yau; Chen, Shinn‐Cherng; Dai, Chia‐Yen; Chuang, Wan‐Long; Huang, Jee‐Fu; Yu, Ming‐Lung

doi:10.1097/md.0000000000004157

Cited by 33 publications

(29 citation statements)

References 36 publications

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“…Previous studies [62][63][64] conducted on IFN-treated patients showed that viral eradication resulted in a significant reduction in liver-related events (hepatic decompensation, variceal bleeding, HCC) in cirrhotic patients. Similarly, two studies [65,66] on noncirrhotic HCV-positive patients with IFN-induced SVR demonstrated a decrease in the incidence of HCC. However, much evidence [63][64][65][66][67][68][69][70][71][72] suggests that DM is an independent predictor of HCC, despite viral eradication obtained by IFN-based therapies.…”

Section: What Is the Clinical Impact Of Daa-induced Svr On The Incidementioning

confidence: 87%

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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Section: What Is the Clinical Impact Of Daa-induced Svr On The Incidementioning

confidence: 87%

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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“…Several factors have been predictive of HCC in the post-SVR period. [46][47][48][49][50] The developed prediction model for HCC has also been created to guide follow-up strategies. 51,52 It is noteworthy that the risk of HCC persists even after 10 years of viral eradication.…”

Section: Hccmentioning

confidence: 99%

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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“…[7–10] In addition, epidemiological studies suggested that DM confers a 2- to 3-fold increase in HCC risk in patients with CHC, regardless of whether the patient has undergone curative hepatectomy or antiviral therapy. [4,10–14] Moreover, the development of HCC may be associated with diabetes duration and antidiabetic drug treatment. [15] …”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus increases the risk of hepatocellular carcinoma in treatment-naïve chronic hepatitis C patients in China

Gao

et al. 2017

Medicine

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We investigated the link between diabetes mellitus (DM) and hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) risk in treatment-naïve chronic hepatitis C (CHC) patients in China.To examine the association between DM and HCC, we conducted a case–control study of 300 Chinese CHC patients with HCC, compared to an age- and sex-matched control group of 517 CHC patients not diagnosed with HCC.We found that DM was more prevalent in the HCC patient group (18.7%) than in the CHC-only patient group (10.8%). We conducted logistic regression analyses adjusting for demographics features and other HCC risk factors and found that DM increased the risk of HCC development nearly 2-fold [adjusted odds ratio (AOR), 95% confidence interval (95% CI), 1.80 (1.17–2.75)]. Meanwhile, the proportion of HCC patients and CHC-only patients with liver cirrhosis were 79.3% and 46.2%, respectively, yielding an AOR of 4.62 (95% CI, 3.31–6.46). Multivariate analyses comparing the risk of HCV-related HCC development in DM patients with and without liver cirrhosis revealed that the estimated AOR (95% CI) for those with liver cirrhosis was 5.60 (2.25–13.96). However, the HCC risk decreased significantly with a later age of diabetes onset (AOR [95% CI], 0.94 [0.89–0.99]).DM was associated with an increased risk for HCC development in treatment-naïve CHC patients in China. Furthermore, liver cirrhosis and an early DM diagnoses further increased the risks of HCC development in patients diagnosed with both CHC and DM.

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Pretreatment glucose status determines HCC development in HCV patients with mild liver disease after curative antiviral therapy

Abstract: Supplemental Digital Content is available in the text

Cited by 33 publications

References 36 publications

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

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

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

Diabetes mellitus increases the risk of hepatocellular carcinoma in treatment-naïve chronic hepatitis C patients in China

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