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. 2020 Feb;27(2):188-194.
doi: 10.1111/jvh.13215. Epub 2019 Dec 2.

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

Francesco Paolo Russo  1   2 , Alberto Zanetto  1   2 , Martina Gambato  2 , Ilaria Bortoluzzi  3 , Ramona Al Zoairy  4 , Enrica Franceschet  1 , Federica De Marchi  5 , Luca Marzi  5 , Erica Nicola Lynch  1 , Annarosa Floreani  1 , Fabio Farinati  1 , Benedikt Schaefer  4 , Patrizia Burra  2 , Heinz Zoller  4 , Andrea Mega  5
Affiliations

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

Francesco Paolo Russo et al. J Viral Hepat. 2020 Feb.

Abstract

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.

Keywords: Diabetes; cirrhosis; direct-acting antivirals; hepatitis C virus.

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References

REFERENCES

    1. WHO, 2019. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c Accessed July 28,2019.
    1. Calzadilla-Bertot L, Vilar-Gomez E, Torres-Gonzalez A, et al. Impaired glucose metabolism increases risk of hepatic decompensation and death in patients with compensated hepatitis C virus-related cirrhosis. Dig Liver Dis. 2016;48(3):283-290.
    1. Ferri C, Sebastiani M, Giuggioli D, et al. Hepatitis C virus syndrome: a constellation of organ- and non-organ specific autoimmune disorders, B-cell non-Hodgkin's lymphoma, and cancer. World J Hepatol. 2015;7(3):327-343.
    1. Gualerzi A, Bellan M, Smirne C, et al. Improvement of insulin sensitivity in diabetic and non diabetic patients with chronic hepatitis C treated with direct antiviral agents. PLoS ONE. 2018;13(12):e0209216.
    1. Negro F. HCV infection and metabolic syndrome: which is the chicken and which is the egg? Gastroenterology. 2012;142(6):1288-1292.

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