No Improvement in Hemoglobin A1c Following Hepatitis C Viral Clearance in Patients With and Without HIV

Chaudhury, Chloe S; Sheehan, Julia; Chairez, Cheryl; Akoth, Elizabeth; Gross, Chloe; Silk, Rachel; Kattakuzhy, Sarah; Rosenthal, Elana; Kottilil, Shyam; Masur, Henry; Hadigan, Colleen

doi:10.1093/infdis/jix517

Cited by 35 publications

(40 citation statements)

References 15 publications

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“…A number of studies have reported significant decreases in HbA1c immediately after SVR . In contrast, a recent report found that reductions in HbA1c immediately following successful treatment were not sustained after a mean duration of 2.5 years . A strength of our longitudinal analysis is that our results allow us to reconcile these apparently conflicting reports.…”

Section: Discussionmentioning

confidence: 65%

Sustained virological response does not improve long‐term glycaemic control in patients with type 2 diabetes and chronic hepatitis C

Gordon

Rupp

et al. 2019

Liver International

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Background: Sustained virological response to treatment for chronic hepatitis C virus may improve short-term glucose control among patients with type 2 diabetes, but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of sustained virological response on long-term trends in haemoglobin A1c in patients with type 2 diabetes.Methods: "Index date" was defined as the date of treatment initiation (treated patients) or hepatitis C virus diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear spline, mixed-effects model to evaluate changes in haemoglobin A1c over a 5-year period.Results: Our sample included 384 hepatitis C virus patients with type 2 diabetes (192 untreated, 192 treated, with sustained virological response or treatment failure).After adjusting for body mass index, haemoglobin A1c was stable among untreated and treatment failure patients. In sustained virological response patients, Hb1Ac trajectories evolved in three phases: (a) index through 6 months post-index, average haemoglobin A1c decreased significantly from 7.7% to 5.4% per 90 days (P < 0.001);(b) 6-30 months post-index, haemoglobin A1c rebounded at a rate of 1.5% every 90 days (P = 0.003); and (c) from 30 months onward, haemoglobin A1c stabilized at

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Section: Discussionmentioning

confidence: 65%

Sustained virological response does not improve long‐term glycaemic control in patients with type 2 diabetes and chronic hepatitis C

Gordon

Rupp

et al. 2019

Liver International

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“…However, in our study, the incidence of new porphyria cutanea tarda cases in the SVR group was 19 (4 in the no‐SVR group), and, although the difference in the numbers is clear and in favour of SVR, it was not statistically significant due to low power. Diabetes has been variably associated with active HCV infection, and some but not all reports indicate a possible improvement in glycaemic control and HgbA1c and decreased inulin use following DAA‐related SVR . However, the attributable fraction to HCV is small, and therefore, the expected reduction in diabetes risk with SVR is expectedly very small.…”

Section: Discussionmentioning

confidence: 99%

The effects of sustained virological response to direct‐acting anti‐viral therapy on the risk of extrahepatic manifestations of hepatitis C infection

El–Serag

Christie

Puenpatom

et al. 2019

Aliment Pharmacol Ther

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Background: Direct-acting anti-viral (DAA) therapy may have a beneficial role in extrahepatic manifestations of hepatitis C virus (HCV) infection. However, the available data are limited. Aim: To examine the effects of DAA treatment on the risk of several extrahepatic manifestations of HCV. Methods: We conducted a retrospective cohort study of patients from the US Department of Veterans Affairs Corporate Data Warehouse who had a positive HCV RNA test and received first course of DAAs between 2012 and 2016. We calculated incidence rates by sustained virological response (SVR) status for six extrahepatic manifestations, and effect of SVR on these conditions was evaluated in adjusted Cox regression models. Results: Of the 45 260 patients treated with DAA with mean follow-up of 2.01 years, 41 711 (92.2%) experienced SVR. Incidence rates ranged from 0.17/ 1000 PY for porphyria cutanea tarda to 21.04/1000 PY for diabetes in the SVR group and 0.51/1000 PY for porphyria cutanea tarda to 23.11/1000 PY for diabetes in the no SVR group. The risk was reduced with SVR for mixed cryoglobulinaemia (adjusted HR (aHR) = 0.23; 95% CI 0.10-0.56), glomerulonephritis (aHR = 0.61; 95% CI 0.41-0.90) and lichen planus (aHR = 0.46; 95% CI 0.30-0.70), but not for non-Hodgkin's lymphoma (aHR = 0.86; 95% CI 0.52-1.43) or diabetes (aHR = 0.98; 95% CI 0.81-1.19). Non significant risk reduction was seen for porphyria cutanea tarda (aHR = 0.33; 95% CI 0.11-1.03). Conclusions: Successful DAA treatment resulting in SVR was associated with significant reductions in the risk of mixed cryoglobulinaemia, glomerulonephritis, lichen planus and possibly porphyria cutanea tarda, but not non-Hodgkin's lymphoma or diabetes. Additional supporting information will be found online in the Supporting Information section at the end of the article. How to cite this article: El-Serag HB, Christie IC, Puenpatom A, Castillo D, Kanwal F, Kramer JR. The effects of sustained virological response to direct-acting anti-viral therapy on the risk of extrahepatic manifestations of hepatitis C infection.

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“…These improvements in glycemic control after SVR could eventually translate into fewer diabetes-related complications. In contrast to improvement in HbA1C with DAA treatment, some authors reported no significant change in the HbA1C level with DAA treatment for Hep C [23,24,25]. Chaudhury et al conducted a prospective study where they showed that achievement of SVR did not lead to improvements in HbA1C [24].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to improvement in HbA1C with DAA treatment, some authors reported no significant change in the HbA1C level with DAA treatment for Hep C [23,24,25]. Chaudhury et al conducted a prospective study where they showed that achievement of SVR did not lead to improvements in HbA1C [24]. Others reported transient improvement but not long-term glycemic control [26].…”

Section: Discussionmentioning

confidence: 99%

Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus

Mada

Malus

Parvathaneni

et al. 2020

International Journal of Hepatology

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Aim. To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM). Methods. We performed a retrospective case-control study in a viral hepatitis ambulatory clinic in Shreveport, Louisiana, during the period 11/01/2014 to 12/31/2017. All the clinic patient ages 18 years and above with treatment-naïve/biopsy-proven chronic hepatitis C and DM (hemoglobin A1C level≥6.5%) who were eligible for treatment were included in the study. Of 118 such patients, 59 were treated with oral DAAs for 8-12 weeks with the goal of achieving a sustained virologic response (SVR). A control group of 59 patients did not receive treatment for their hepatitis C and was followed in the clinic. Patients in the control group did not receive treatment either due to insurance issues or refusal of hepatitis C treatment. Results. Fifty-five of the 59 patients treated with DAAs (93%) achieved a SVR. Six months after treatment completion, their mean±SEM HbA1C level had decreased by 1.1±0.03% (P<0.0001). Four of the 59 patients treated with DAAs did not achieve a SVR. Their mean HbA1C 6 months after treatment completion had increased by 0.8±0.2%. Furthermore, there was no improvement in HbA1C levels over time in the untreated group (mean HbA1C increase, 0.2±0.05%; P<0.0001 vs. the treatment group, which had a mean HbA1C decrease of 0.9±0.2%). Conclusion. This controlled study demonstrated that treatment of chronic hepatitis C with DAAs results in statistically significant and meaningful reductions in hemoglobin A1C levels in patients with coexisting diabetic mellitus if a SVR is achieved.

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No Improvement in Hemoglobin A1c Following Hepatitis C Viral Clearance in Patients With and Without HIV

Cited by 35 publications

References 15 publications

Sustained virological response does not improve long‐term glycaemic control in patients with type 2 diabetes and chronic hepatitis C

Sustained virological response does not improve long‐term glycaemic control in patients with type 2 diabetes and chronic hepatitis C

The effects of sustained virological response to direct‐acting anti‐viral therapy on the risk of extrahepatic manifestations of hepatitis C infection

Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus

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