Effect of Sustained Virological Response with Direct Acting Antiviral Agents on Insulin Resistance in Patients with Chronic HCV Infection

Abstract

Background Infection with hepatitis C virus (HCV) is a major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma worldwide. Liver disease is not the only problem caused by chronic HCV infection; many extra-hepatic complications such as insulin resistance (IR) can be associated with HCV infection as well. Objective To assess the effect of sustained virological response on insulin resistance in patients with chronic hepatitis C infection. Patients and methods This study was conducted in New Cairo Viral Hepatitis Treatment Center (NCVHTC), in the period between December 2017 and December 2018. The current study was conducted on 46 enrolled HCV patients with type 2 Diabetes Mellitus (T2DM). Fasting Insulin (FI) and fasting blood glucose (FBG) as well as lipid profile were assessed in all patients at three time points; before treatment, at the end of treatment (EOT) and 12 weeks after the EOT. Results Despite using 4 different DAA regimens, all patients achieved SVR regardless of the regimen used. As a measurement of IR, HOMA-IR was calculated at the three time points using FI & FBG, it was found that HOMA-IR decreased significantly at the EOT; however, when calculated at week 12 after EOT, the reduction of HOMA-IR was not significant compared to the baseline levels. on the other hand, total cholesterol & LDL increased at the EOT and continued to increase at 12 weeks after the EOT. Conclusion Improvements in IR and glycemic control were not statistically significant after achieving sustained virologic response (SVR) with DAAs in patients with chronic HCV infection. Changes in the lipid profile such as an increase in the levels of total cholesterol and LDL can be expected after treatment with DAAs.