Published online Sep 27, 2018. doi: 10.4254/wjh.v10.i9.612
Peer-review started: April 7, 2018
First decision: May 7, 2018
Revised: May 9, 2018
Accepted: May 23, 2018
Article in press: May 24, 2018
Published online: September 27, 2018
To determine whether successful treatment with directacting antivirals (DAA) is associated with improvements in hemoglobin A1c (HbA1c) and if type 2 diabetes mellitus (T2DM) or metabolic syndrome affects sustained virologic response (SVR).
We performed a retrospective analysis of all hepatitis C virus (HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment (SVR12).
A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2DM. Within that cohort, patients who achieved SVR12 had lower mean HbA1c pre treatment (7.35 vs 8.60, P = 0.02), and lower mean HbA1c post-treatment compared to non-responders (6.55 vs 8.61, P = 0.01). The mean reduction in HbA1c after treatment was greater for those who achieved SVR12 than for non-responders (0.79 vs 0.01, P = 0.03). In adjusted models, patients that achieved SVR12 were more likely to have a HbA1c decrease of ≥ 0.5 than those that did not achieve SVR12 (adjusted OR = 7.24, 95%CI: 1.22-42.94).
In HCV patients with T2DM, successful treatment with DAA was associated with a significant reduction in HbA1c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore, the presence of T2DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.
Core tip: The relationship of chronic hepatitis C virus (HCV) and type 2 diabetes mellitus is complex and lesser is known about its relationship to metabolic syndrome. While metabolic syndrome and type 2 diabetes may have had negative outcomes during the era of pegylated-interferon, research is being actively pursued to understand how direct acting antivirals (DAA) may affect these comorbidities. In this study, we show that unlike with pegylated-interferon, direct active antiviral success rates are not affected by the presence of metabolic syndrome. We further show that successful treatment of HCV with DAAs actually leads to better glycemic control 1-year post-treatment.