High Prevalence of Hepatitis C Infection in Afro‐Caribbean Patients with Type 2 Diabetes and Abnormal Liver Function Tests

Abstract

Moderate elevations of serum transaminases are frequently found in patients with diabetes mellitus and are often attributed to fatty infiltration of the liver without further investigation. Recent studies of patients with end-stage liver disease have suggested a possible association between Hepatitis C virus (HCV) antibody positivity and the development of diabetes (mostly Type 2). As a first step in the examination of any potential association between HCV and Type 2 diabetes in subjects without overt liver disease, we examined 200 British patients with Type 2 diabetes (100 White Caucasians, 50 Asians, and 50 Afro-Caribbeans), recruited from the United Kingdom Prospective Study of Diabetes, half of whom had a significant elevation of alanine aminotransferase (ALT) on at least two occasions and half of whom had consistently normal ALT levels. In Afro-Caribbean Type 2 diabetic subjects 7/25 (28%) patients with abnormal ALT and 1/25 (4%) with normal ALT were HCV antibody positive. Among White Caucasian subjects 6/50 (12%) patients with abnormal LFTs and 0/50 with normal LFTs were HCV antibody positive and in Asians the prevalence was 2/25 (8%) and 0/25, respectively. This study suggests that persistent mild to moderate elevation of serum transaminases in a patient with Type 2 diabetes should not automatically be attributed to the metabolic disturbances of diabetes. Particularly in Afro-Caribbean subjects, HCV infection is a major diagnostic consideration. The question of whether HCV infection itself may have a diabetogenic action is worthy of further investigation.

Prevalence of Hepatitis C Infection Among Diabetics Type 2 at Sharkia Governorate, Egypt

“…The present study showed that the overall prevalence of HCV antibodies in type 2 diabetic patient at Sharkia governorate is 38.7 % which is much higher than that reported by The Egypt Demographic and Health Survey (2008 EDHS), which stated that the prevalence of HCV in general population is 14.7% among a nationally representative sample of 11,126 Egyptians aged 15-59 years old. The higher prevalence of HCV antibodies in type 2 diabetic patients than general population is in agreement with previous studies that have noted a 2-to 10-fold increase in the sero-prevalence of HCV infection in diabetic patients (15) (16) . Also in a study conducted in 2004, Custro et al (17) stated that, about 42.3% of the patients with impaired glucose tolerance were infected with HCV.…”

Prevalência de infecção pelo vírus da hepatite C em pacientes com diabetes melito tipo 2

“…Prevalência de infecção pelo vírus da hepatite C em pacientes com diabetes melito tipo 2 até 28%, sendo que os maiores índices são encontrados quando se analisam particularmente os diabéticos com elevação das aminotransferases (5,14,17,18,19) . Neste estudo os pacientes com DM tipo 2 apresentaram taxas mais elevadas de ALT que os diabéticos tipo 1 (P <0,01).…”

“…Mais recentemente, estudos epidemiológicos sugerem que o diabetes melito (DM) possa representar também manifestação da infecção crônica pelo VHC (12,13) . Vários autores relataram prevalência aumentada de infecção pelo VHC em diabéticos tipo 2, em contraste com a população geral (5,15,18,19) . A possível associação entre VHC e DM também é sugerida por estudos transversais que encontraram prevalência aumentada de DM tipo 2 em pacientes com hepatite crônica C, quando comparada à observada em pacientes com outras formas de doença hepática crônica, mesmo na ausência de cirrose (1,2,6,9,11,13) .…”

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

“…Asymptomatic, moderate serum aminotransferase elevation has frequently been found in patients with DM, particularly in those with T2DM [24,25] . This phenomenon has often been related to fatty infiltration of the liver without further investigation [26,27] . In particular, steatosis has been related to IR and T2DM, beyond intracellular fat accumulation [28] .…”