Genetic Variants in Interleukin-28B Are Associated with Diabetes and Diabetes-Related Complications in Patients with Chronic Hepatitis C Virus Infection

Prevalence of Type 2 Diabetes Mellitus among Hepatitis C Virus-Infected Patients: A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> The ever-increasing global prevalence of hepatitis C infection is fueling the burden of diabetes mellitus, which exacerbates various complications and may be a cause of death of millions of people. Several studies have reported that hepatitis C virus infection is an important risk factor for the development of diabetes mellitus. However, fragmented studies have reported variable and inconsistent findings regarding the prevalence of type 2 diabetes mellitus among hepatitis C virus-infected patients. Therefore, this meta-analysis aimed to estimate the overall prevalence of type 2 diabetes mellitus among patients infected with hepatitis C virus. <b><i>Methods:</i></b> This systematic review and meta-analysis includes original articles reporting on cohort and cross-sectional studies. A systematic search was performed in PubMed, ScienceDirect, and Google Scholar. A random-effects meta-analysis model was used to estimate the global pooled prevalence of type 2 diabetes mellitus among hepatitis C-infected patients. A sensitivity analysis was conducted to check the stability of the summary estimate. Heterogeneity was assessed using the <i>I</i>² statistic. A subgroup analysis was also conducted based on geographical region. Funnel plots were used to spot publication bias. <b><i>Results:</i></b> A total of 40 eligible articles reporting data on 14,765 study participants were included in this meta-analysis. The pooled prevalence of type 2 diabetes mellitus among hepatitis C virus-infected patients was 19.67% (95% CI: 17.25, 22.09). The subgroup analysis showed a pooled prevalence of 27.72% (95% CI: 20.79, 34.65) in Africa, 20.73% (95% CI: 17.57, 23.90) in Asia, 16.64% (95% CI: 6.79, 26.49) in North America, and 15.02% (95% CI: 10.66, 19.38) in Europe. <b><i>Conclusions:</i></b> The overall prevalence of type 2 diabetes mellitus among hepatitis C virus-infected patients was considerably higher than in the general population in a global perspective. The highest prevalence was noted in Africa and Asia, followed by North America and Europe. Therefore, early intervention is needed (prevention and early treatment of hepatitis C virus infection) to prevent the development of type 2 diabetes mellitus.

Risk of hepatocellular carcinoma after sustained virological response in Veterans with hepatitis C virus infection

The long-term prognosis in terms of risk or predictors of developing hepatocellular carcinoma (HCC) among patients with sustained virological response (SVR) remains unclear. We conducted a retrospective cohort study using data from the Veterans Affairs VA hepatitis C virus (HCV) Clinical Case Registry in patients with positive HCV RNA between October 1999 and August 2009 and follow-up through December 2010. HCV treatment (interferon with or without ribavirin) and SVR (RNA test negative at least 12 weeks after the end of treatment) were determined. We used Cox's proportional hazards models to calculate hazard ratios (HRs) for potential predictors (demographic, virological, and clinical) associated with HCC development post-SVR. We identified 33,005 HCV-infected individuals who received treatment, of whom 10,817 achieved SVR. Among these patients, 100 developed new HCC during a total follow-up of 30,562 person-years for an overall incidence rate of 0.33% per year. Annual risk of HCC remained considerably high among patients with cirrhosis (1.39%) and those cured after age 64 (0.95%). Patients with diabetes (adjusted HR = 1.88; 1.21-2.91) or genotype 3 infection (adjusted HR = 1.62; 0.96-2.734) were significantly more likely to develop HCC.

CONCLUSIONS

Risk of HCC after HCV cure, though considerably reduced, remains relatively high at 0.33% per year. Older age and/or presence of cirrhosis at the time of SVR are associated with a high enough risk to warrant surveillance. Diabetes is also a risk factor for post-SVR HCC. (Hepatology 2016;64:130-137).

Association of Overt Diabetes Mellitus with the Non-CC but not the CC Genotype of Interleukin-28B in Hepatitis C Virus Infected Patients

BACKGROUND

Interleukin-28B (IL-28B) polymorphism is an important predictor for hepatitis C virus (HCV) treatment response. Whether IL-28b genotypes also influence other nontreatment related clinical parameters is unclear.

METHODS

Patients with HCV-related chronic liver diseases who attended our department during 2012-2014 were retrospectively analyzed. The single nucleotide polymorphisms (SNPs) of rs12979860 (IL-28B) were correlated with various clinical parameters. We also compared these parameters in patients with and without overt diabetes to identify possible associations.

RESULTS

A total of 115 patients were included (median age 48, range 15-76 years; 70% males). Overall, 43/115 (37%) patients had chronic hepatitis, while the remaining 72/115 (63%) had cirrhosis. The most common IL-28B genotype was CC, which was found in 53% of patients (61/115), while the remaining 47% were nonCC [CT 42% (48/115) and TT 5% (6/115)]. Clinical and laboratory parameters like Hb, white blood cell (WBC), platelets, bilirubin, transaminases, and albumin were similar in the CC and nonCC genotypes. Overt diabetes mellitus was present in 22% (25/115) of patients. Patients with nonCC genotype had significantly higher prevalence of overt diabetes mellitus than patients with CC genotype (31% [17/54] versus 13% [8/61]; p < 0.05). When parameters were compared in patients with and without overt diabetes mellitus, only IL-28B and age were significantly associated with overt diabetes mellitus (p < 0.05).

CONCLUSION

In HCV patients, overt diabetes mellitus was more commonly associated with the nonCC genotype of IL-28B than the CC genotype. Carriers of the T-allele of SNP rs12979860 were more likely to have insulin resistance than CC homozygotes, and this finding may explain the higher prevalence of diabetes in non-CC genotypes. Thus, an IL-28B test may be useful in patients of HCV in order to determine their likelihood of developing diabetes mellitus.