Insulin Resistance Reduction After Sustained Virological Response With Direct Acting Antiviral:not Every Population Improves

Andrade, Vanessa Gutierrez de; Yamashiro, Fábio da Silva; Oliveira, Cássio Vieira de; Moreira, Aldenise Alves; Winckler, Fernanda Cristina; Silva, Giovanni Faria

doi:10.1590/s0004-2803.201800000-69

Cited by 7 publications

(5 citation statements)

References 31 publications

(38 reference statements)

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“…After therapy, all patients achieved SVR and significant improvement of the glycemic curve and ISI, despite there being no change of BMI and lifestyle. Similar results were described by a recent Brazilian study [40] that monitored HOMA-IR to verify changes in IR in patients with CHC treated with DAAs. HOMA-IR was significantly improved only in nondiabetic patients with a pretherapy HOMA-IR > 2.5.…”

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

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: Does Svr Achieved By Daas Significantly Prevent the Onset Ofsupporting

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 different outcomes in research could be explained by previous characteristics of the studied population. While in the general population of the study conducted by Andrade et al there was an increase of glucose and HOMA-IR in the 12th week after completing treatment, the same could not be observed if diabetic patients and those with previously normal HOMA-IR were excluded (49) .…”

Section: Discussionmentioning

confidence: 85%

Curing Hepatitis C With the New Direct Acting Antivirals Did Not Improve Insulin Resistance After One Year

Strauhs-Nitsch

Campiolo

Morsoletto

et al. 2020

Arq. Gastroenterol.

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BACKGROUND: Chronic hepatitis C still figures as an important cause of morbidity among the Brazilian population, and is closely associated with metabolic disturbances, including insulin resistance (IR), which can be evaluated by the Homeostatic Model Assessment (HOMA-IR). IR may entail lower sustained virologic response (SVR) on certain therapeutic regimens and faster progression to advanced hepatic fibrosis. With the arrival of the direct acting agents (DAA) in hepatitis C treatment, there is an increased need in observing the impact in patients’ IR profile while using such therapies. OBJECTIVE: - 1) To compare the results of HOMA-IR in patients affected by chronic hepatitis C before treatment with DAA and 12 months after finishing it with SVR. 2) To evaluate the evolution of weight after curing chronic hepatitis C. METHODS: We included patients older than 18 from two tertiary care in Curitiba - PR, of both sexes, with chronic hepatitis C, treated with DAA, from July 2015 to September 2017. We also evaluated the patients’ levels of fasting insulin, fasting glucose and glycated hemoglobin before starting treatment and 12 months after finishing it. We also used epidemiologic data, such as age, sex, hepatic fibrosis degree, body mass index, abdominal circumference, viral genotype and the presence of diabetes mellitus before and after treatment. IR was assessed before and after treatment and calculated by the HOMA-IR score. Insulin resistance was defined by a HOMA-IR greater than 2.5. We excluded patients who lost follow-up, those who did not achieve SRV and those who did not have a laboratory profile. The results of quantitative variables were described by means, medians, and standard deviations. P values <0.05 indicated statistical significance. RESULTS: We included 75 patients in this study, with a mean age of 55.2 years and 60% of males. Forty-three patients had advanced fibrosis. Twenty one (28%) had a previous diabetes mellitus diagnosis. We identified 31 (41.3%) patients with IR before antiviral treatment, and this number increased to 39 (52%) after 12 months of finishing treatment, according to HOMA-IR. There was no statistic difference between insulin, glucose and HOMA-IR measurements before and after curing hepatitis C. We observed a weight gain in patients shortly after curing hepatitis C, but this did not persist at the end of the study. We also had no significant difference in IR prevalence when viral genotype was concerned. CONCLUSION: In this study, there was no statistically significant difference between HOMA-IR results in patients before and 12 months after treatment for hepatitis C. Even though patients gained weight after the cure, this was not statistically significant after a year (P=0.131).

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“…A retrospective study with 281 participants (31) identified a significant improvement in fasting glucose and a reduction in the rate of prediabetes after SVR, but this beneficial effect did not extend to patients with cirrhosis. In contrast, a Brazilian study (32) with 150 patients demonstrated that insulin resistance did not improve after SVR was obtained with DAAs. In the same study, the authors found that after excluding patients with DM and those with a normal baseline HOMA-IR index (<2.5), the mean blood glucose level, insulin level and HOMA-IR index decreased significantly (p = 0.02) after SVR.…”

Section: Discussionmentioning

confidence: 86%

Impact of hepatitis C virus eradication with direct-acting antivirals on glycidic metabolism

Sparvoli¹,

Sparvoli²,

Dumith³

et al. 2022

Archives of Endocrinology and Metabolism

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Objective: To compare the glucose metabolism of patients with chronic hepatitis C virus infection treated with direct-acting antivirals (DAAs) in pretreatment and sustained viral response (SVR) periods. Materials and methods: This was an intervention pre-post study of 273 patients with chronic hepatitis C virus infection treated with DAAs from March 2018 to December 2019. Glycidic metabolism was evaluated through homeostasis model assessment (HOMA) -insulin resistance (IR) and HOMA-β indices and assessments of insulinemia and HbA1c levels. These parameters were analyzed with a T test by paired comparison of the means of the variables and Wilcoxon's test paired for the median; in the variables with an abnormal distribution, the Z score was generated for the mean in both the pretreatment and SVR periods. Statistical significance was considered at p ≤ 0.05. Results: Among 273 participants, 125 (45.8%) had prediabetes, and 50 (18.3%) had diabetes. In SVR, there was a significant increase in platelets, albumin, alkaline phosphatase, cholesterol and triglycerides and a significant decrease in aspartate aminotransferase, alanine aminotransferase, gamma GT and bilirubin. The HOMA-IR and HOMA-β indices increased in SVR from 1.95 to 2.29 (p = 0.087) and 71.20 to 82.60 (p = 0.001), respectively. Insulinemia increased from 7.60 μU/mL to 8.90 μU/mL (p = 0.011). HbA1c decreased from 5.6 to 5.4 (p < 0.001). Among patients with prediabetes and those with diabetes, the reduction in HbA1c values was significant (p = 0.006 and p = 0.026, respectively). Conclusion: SVR significantly impacts and leads to improvement in glucose metabolism in patients with chronic liver disease induced by hepatitis C virus.

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Insulin Resistance Reduction After Sustained Virological Response With Direct Acting Antiviral:not Every Population Improves

Cited by 7 publications

References 31 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

Curing Hepatitis C With the New Direct Acting Antivirals Did Not Improve Insulin Resistance After One Year

Impact of hepatitis C virus eradication with direct-acting antivirals on glycidic metabolism

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