Insulin resistance does not impair response of chronic hepatitis C virus to direct-acting antivirals, and improves with the treatment

Elhelbawy, Mostafa; Abdel-Razek, Waël; Alsebaey, Ayman; Hashim, Mohamed; Elshenawy, Hassan; Waked, Imam

doi:10.1097/meg.0000000000001215

Cited by 16 publications

(12 citation statements)

References 41 publications

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“…Stine et al, when studying a group of 175 patients with chronic hepatitis C treated with DAAs, couldn't show a statistical significance in glucose profile before and after treatment (46) .Those results were also shared by Chaudhury et al, who did not identify sustained benefits to glycaemic levels following HCV clearance irrespective of HIV, diabetes or fibrosis stage (47) . It´s interesting to note that our patients had higher levels of HOMA-IR both before and after SVR when compared to other studies (44,48) , which could also justify our findings.…”

Section: Discussionsupporting

confidence: 83%

“…The exact effects of virus C treatment on glucose profile are still not completely known, although some studies show a direct relation between SVR and decreasing IR (39,40,41,42,43) . Elhelbawy et al, when researching 511 patients treated for HCC with the new DAAs, showed a significant reduction on IR (44) . A study by Ciancio et al on 101 patients shares this conclusion, while also demonstrating a decrease in fasting glucose and glycated haemoglobin (45) .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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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“…After the widespread adoption of highly effective direct‐acting antivirals (DAAs), preliminary data from case series and cohort studies confirmed what previously described in the IFN era . However, most of them were mono‐centric and/or retrospective, with a relatively short duration of follow‐up.…”

Section: Introductionsupporting

confidence: 54%

Hepatitis C virus eradication with direct‐acting antiviral improves insulin resistance

Russo

Zanetto

Gambato

et al. 2019

Journal of Viral Hepatitis

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Sustained virological response (SVR) after interferon-based therapy is associated with improvement of insulin resistance (IR) in HCV-infected patients. Few data are available in the direct-acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long-term effect of DAAs on IR. Patients treated with DAAs between May 2015 and December 2016 in 3 tertiary care centres were recruited. Patients with diabetes were excluded. Biochemical and virological data were collected at baseline, 12/24/48 weeks (W) after the end of therapy (EOT). Presence of IR was defined by a 'homeostasis model assessment index for IR' [HOMA-IR])> 2.5. Liver fibroscan was performed at baseline, at 24/48W after EOT. Hundred and thirty-eight patients were enrolled (mean age 58 years, M/F 85/53, GT1 61%, 68.8% cirrhotic). Sixty-eight patients (94/138) had IR. Patients with IR had significantly higher stiffness than patients without it (23 ± 12 vs 15 ± 8; P < .0001). SVR12 was achieved in 135 (98%) patients, and 124 (90%) patients reached the 48W post-EOT.At this time point, the percentage of patients with IR significantly decreased to 49% (P = 0,01). HOMA-IR was significantly lower than baseline (1.8 vs 3; P < .001), and this was related to a significant reduction of insulin level (11.7 ± 6.3 vs 16.4 ± 8.3). High BMI was associated with a significantly lower probability of achieving a non-IR status at 24W (P = .05) and 48W (P = .03).In conclusion, SVR following DAAs led to a significant reduction of IR, even in patients with cirrhosis. Nevertheless, IR can persist after the achievement of SVR, especially in patients with high BMI. K E Y W O R D S cirrhosis, Diabetes, direct-acting antivirals, hepatitis C virus | 189 RUSSO et al.

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“…Compared to interferon and ribavirin therapies alone, DAAs have higher potency, higher safety, lower side effects and shorter treatment durations and have been widely used in most countries. Insulin resistance did not impair the response of CHC patients treated with DAAs 29 . Currently, many studies on DAA treatments for HCV have also demonstrated the potential benefit in glucose metabolism after SVR [30][31][32][33][34][35][36] .…”

Section: Continuedmentioning

confidence: 79%

Hepatitis C Virus Clearance with Glucose Improvement and Factors Affecting the Glucose Control in Chronic Hepatitis C Patients

Yuan

Zhou

et al. 2020

Sci Rep

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The study aimed to investigate whether the glucose level improves and what factors affect the improvement in glucose control after the eradication of hepatitis C virus (HCV). A total of 1090 patients with HCV infections were enrolled, among which 278 (25.5%) patients were diagnosed with prediabetes, and 89 (8.16%) patients were diagnosed with diabetes. In the cohort, 990 patients belonged to sustained virological response (SVR) group and 100 belonged to non-SVR group. Decreases in the fasting plasma glucose (FPG) level were found in the SVR group but not in the non-SVR group (p < 0.001; p = 0.267). In the SVR group, subjects with baseline FPG ≥ 5.6 mmol/L were further stratified into glycometabolism-improved (N = 182) and unimproved (N = 150) groups according to their FPG after viral eradication. Multivariate analysis showed that older age, higher baseline HCV RNA, glucose, total bilirubin and alanine aminotransferase levels were independent risk factors for insufficient glucose improvement. In conclusion, patients with HCV infection had a higher prevalence of abnormal glycometabolism. It could be improved after viral eradication, indicating that HCV may influence glycometabolism. Moreover, Age, baseline HCV RNA, glucose, total bilirubin and alanine aminotransferase levels were impact factor for glycometabolism improvement after viral eradication.

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Insulin resistance does not impair response of chronic hepatitis C virus to direct-acting antivirals, and improves with the treatment

Abstract: IR does not impair the response of patients with HCV treated with DAAs, and improves significantly in patients who achieve an SVR.

Cited by 16 publications

References 41 publications

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

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

Hepatitis C virus eradication with direct‐acting antiviral improves insulin resistance

Hepatitis C Virus Clearance with Glucose Improvement and Factors Affecting the Glucose Control in Chronic Hepatitis C Patients

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