2020
DOI: 10.3390/jcm9020563
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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

Abstract: 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 elect… Show more

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Cited by 22 publications
(22 citation statements)
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“…In the era of direct‐acting antivirals for HCV, SVR rates of almost 100% are being reached, inducing clear benefits on the alteration of homoeostasis of glucose metabolism associated with HCV infection, including improvement of insulin resistance and reduced onset of de novo insulin resistance and type 2 diabetes in patients without advanced cirrhosis or long‐term diabetic history 42 . For HCV patients with type 2 diabetes, whether the beneficial short‐terms outcomes of DAA‐induced HCV clearance are maintained and of clinical significance in the long term remains unclear 43 …”
Section: Discussionmentioning
confidence: 99%
“…In the era of direct‐acting antivirals for HCV, SVR rates of almost 100% are being reached, inducing clear benefits on the alteration of homoeostasis of glucose metabolism associated with HCV infection, including improvement of insulin resistance and reduced onset of de novo insulin resistance and type 2 diabetes in patients without advanced cirrhosis or long‐term diabetic history 42 . For HCV patients with type 2 diabetes, whether the beneficial short‐terms outcomes of DAA‐induced HCV clearance are maintained and of clinical significance in the long term remains unclear 43 …”
Section: Discussionmentioning
confidence: 99%
“…As a result of ethical and legal issues, all HCV‐positive diabetic patients had to be treated in our Unit. However, in the studies published so far, 8,9 untreated or non‐responding patients used as controls did not show any significant variations in their glycometabolic control throughout the follow‐up. Conversely, we acknowledge the possibility that untreated or non‐responding diabetic patients might show an even worse clinical outcome compared to cured diabetic patients.…”
Section: Discussionmentioning
confidence: 77%
“…Thus, it is reasonable to hypothesize that viral clearance might be accompanied by an improvement in glucose abnormalities. Two recent reviews 8,9 reported that the majority of the studies published so far found a significant glycaemic amelioration after achievement of sustained virological response (SVR) by direct‐acting antiviral agents (DAAs); however, some studies 10‐13 failed to observe any significant glycometabolic changes. The issue of the long‐term beneficial effect of SVR on glycaemic control in diabetic patients was addressed by few reports 10,12,14‐19 showing conflicting and contradictory results.…”
Section: Introductionmentioning
confidence: 99%
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“…In contrast to prior experiences with IFN-based treatments, the presence of insulin resistance or type 2 diabetes mellitus did not appear to diminish the rate of sustained virological response (SVR) to DAA treatments [6]. Conversely, while several early studies had suggested that DAA-associated SVR improves the metabolic status, two of those studies did not observe long-term glycemic control [7]. Though the current study did not examine if DAA treatment changed insulin resistance, these data are unlikely to be available in an administrative retrospective study, especially since insulin resistance is not measured in routine clinical practice.…”
mentioning
confidence: 78%