Metabolic syndrome does not affect sustained virologic response of direct-acting antivirals while hepatitis C clearance improves hemoglobin A1c

Abstract

AIMTo 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).METHODSWe 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).RESULTSA 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).CONCLUSIONIn 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.

Systematic review: chronic viral hepatitis and metabolic derangement

“…The effect of MetS on the response of DAA to treatment was limited. One recent study reported that MetS did not negatively affect the sustained viral response (SVR) …”

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

“…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] . A retrospective single-center observational study from Philip Weidner et al investigated 281 patients receiving DAA ± Ribavirin and measured FPG.…”

Real‐world effectiveness and safety of ledipasvir/sofosbuvir for genotype 6 chronic hepatitis C patients in Taiwan

“…The HbA1c level fell shortly after LDV/SOF. The results in this study revealed a decline of HbA1c in both DM and non‐DM patients following the SVR, indicating that better sugar control may be a favorable result of successful DAA treatment in CHC patients . However, parameters associated with insulin, insulin resistance, and beta‐cell function remained unchanged in this study.…”

“…The results in this study revealed a decline of HbA1c in both DM and non-DM patients following the SVR, indicating that better sugar control may be a favorable result of successful DAA treatment in CHC patients. [30][31][32] However, parameters associated with insulin, insulin resistance, and beta-cell function remained unchanged in this study. The long-term effect of the successful clearance of HCV by DAA on insulin activity and insulin resistance is of interest and important to investigate.…”