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He Z, Lin Y, Dong S, Ke Q, Zheng S, Ling Q. Development and validation of a nomogram model for predicting chronic kidney disease after liver transplantation: a multi-center retrospective study. Sci Rep 2023; 13:11380. [PMID: 37452094 PMCID: PMC10349045 DOI: 10.1038/s41598-023-38626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
Chronic kidney disease (CKD) is a frequent complication after liver transplantation (LT) and associated with poor prognosis. In this study, we retrospectively analyzed 515 adult patients who underwent LT in our center. They were randomly divided into a training set (n = 360) and an internal test set (n = 155). Another 118 recipients in other centers served as external validation set. Univariate and multivariate COX regression analysis were used to determine risk factors. A nomogram model was developed to predict post-LT CKD. The incidence of post-LT CKD in our center was 16.9% (87/515) during a median follow-up time of 22.73 months. The overall survival of recipients with severe CKD (stage IV and V) were significantly lower than those with non or mild CKD (stage III) (p = 0.0015). A nomogram model was established based on recipient's age, anhepatic phase, estimated glomerular filtration rate and triglyceride levels at 30 days after LT. The calibration curves for post-LT CKD prediction in the nomogram were consistent with the actual observation in both the internal and external validation set. In conclusion, severe post-LT CKD resulted in a significantly reduced survival in liver recipient. The newly established nomogram model had good predictive ability for post-LT CKD.
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Affiliation(s)
- Zenglei He
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yimou Lin
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Siyi Dong
- China Liver Transplant Registry, Hangzhou, 310003, China
| | - Qinghong Ke
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Qi Ling
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Angel M, Petrosyan Y, Doyle MA, Cooper C. HCV infection characteristics, treatment uptake and outcomes in patient with diabetes mellitus. BMC Endocr Disord 2022; 22:277. [PMID: 36371200 PMCID: PMC9652941 DOI: 10.1186/s12902-022-01198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The interplay between HCV, DM, and DAA therapy is poorly understood. We compared HCV infection characteristics, treatment uptake, and treatment outcomes in patients with and without DM. METHODS: A retrospective cohort study was conducted using data from The Ottawa Hospital Viral Hepatitis Program. Statistical comparisons between diabetes and non-diabetes were made using χ2 and t-tests. Logistic regression analyses were performed to assess predictors of DM and SVR. RESULTS One thousand five hundred eighty-eight HCV patients were included in this analysis; 9.6% had DM. Patients with DM were older and more likely to have cirrhosis. HCC and chronic renal disease were more prevalent in the DM group. Treatment uptake and SVR were comparable between groups. Regression analysis revealed that age and employment were associated with achieving SVR. Post-SVR HCC was higher in DM group. CONCLUSION The high prevalence of DM in our HCV cohort supports screening. Further assessment is required to determine if targeted, early DAA treatment reduces DM onset, progression to cirrhosis and HCC risk. Further studies are needed to determine if optimization of glycemic control in this population can lead to improved liver outcomes.
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Affiliation(s)
- Marina Angel
- Ottawa Hospital Research Institute, G12-501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Yelena Petrosyan
- Ottawa Hospital Research Institute, G12-501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Mary-Anne Doyle
- Ottawa Hospital Research Institute, G12-501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, G12-501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada.
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Ramadan MS, Boccia F, Moretto SM, De Gregorio F, Gagliardi M, Iossa D, Durante-Mangoni E, Zampino R. Cardiovascular Risk in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals. J Clin Med 2022; 11:jcm11195781. [PMID: 36233646 PMCID: PMC9572655 DOI: 10.3390/jcm11195781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic hepatitis C (CHC) is associated with hepatic and extrahepatic complications, including cardiovascular disease (CVD). The effects of sustained virological response (SVR) and liver fibrosis on CVD risk are not well established. Aims: We aim to assess the dynamics of Fibrosis-4 (FIB-4) and Atherosclerotic Cardiovascular Disease 2013 (ASCVD) scores up to three years after direct acting antivirals (DAA) treatment and explore the time-dependent association between the two scores. Methods: We included consecutive CHC patients treated with DAA and followed up with them for three years. Outcomes were changes from baseline (before DAA) in ASCVD and FIB-4 scores, measured at the end of treatment, 12-, 24-, and 36-months follow-up. Results: In total, 91 patients with CHC were finally included (median age: 66 years (IQR = 58−72 years); 43% females). Median follow-up was 2 years (1−3 years) and all patients reached SVR. The ASCVD score did not significantly change from baseline (Mean = 17.2%, 95% CI 14.1, 20.3), but the FIB-4 score significantly decreased at any time-point by an average of 0.8 (95% CI 0.78, 0.82, p < 0.001). Elevated FIB-4 scores at one (β = 1.16, p < 0.001) and three years (β = 2.52, p < 0.001) were associated with an increased ASCVD score. Clinically, two participants- with non-decreasing FIB-4 scores after treatment- had acute coronary syndrome at the end of treatment and one year follow-up, respectively. Conclusions: In our study, we found that FIB-4 and ASCVD scores exhibited a positive correlation irrespective of time-point after treatment. Larger studies are essential to further investigate the utility of FIB-4 scores in cardiovascular risk assessment.
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Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
| | - Filomena Boccia
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Simona Maria Moretto
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Fabrizio De Gregorio
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Massimo Gagliardi
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Domenico Iossa
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7702645
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
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Alzahrani N. Hepatitis C Virus, Insulin Resistance, and Diabetes: A Review. Microbiol Immunol 2022; 66:453-459. [PMID: 35941761 DOI: 10.1111/1348-0421.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
Hepatitis C virus (HCV) infection and diabetes mellitus (DM) are two chronic diseases that are a cause of significant health and economic burdens worldwide. HCV is associated with the development of insulin resistance (IR) and diabetes mellitus (DM). The mechanisms through which HCV induces IR and DM include direct viral effects, pro-inflammatory cytokines and other immune-mediated processes. Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are both chronic diseases that involve impaired glucose homeostasis, albeit through different mechanisms. T1DM is an autoimmune disease that leads to the destruction of pancreatic beta cells resulting in insulin deficiency. In T2DM, a combination of peripheral insulin resistance and irregular production of insulin eventually lead to beta cell destruction and insulin insufficiency. Both type 1 and type 2 DM etiologies involve a combination of genetic and environmental factors. The data on HCV and T1DM association is limited, unlike T2DM, where a large body of evidence linking HCV to T2DM is available. Here, we intend to outline the current state of knowledge on HCV, IR, and DM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nabeel Alzahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
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El-Kassas M, El-Folly R, Aboromia M, Aly H, Bahgat M, Hamed M. Effect of achieving sustained virological response with direct-acting antiviral agents on glycemic control in diabetic patients with chronic hepatitis C infection. Egypt Liver Journal 2022. [DOI: 10.1186/s43066-022-00190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Abstract
Background
Hepatitis C virus (HCV) is a significant cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide. Liver disease is not the only problem caused by chronic HCV infection; many extrahepatic complications, such as insulin resistance, can be associated with HCV infection. The aim of this study was to assess the effect of achieving a sustained virological response after treatment with directly acting antiviral drugs on insulin resistance in patients with chronic HCV infection.
Results
This prospective study was conducted on 46 HCV patients with type 2 diabetes mellitus who received directly acting antiviral drugs for HCV infections. Fasting insulin, fasting blood glucose, and lipid profiles were assessed in all patients at three time points: before treatment, at the end of treatment, and 12 weeks after the end of treatment. Despite using three different directly acting antiviral drug regimens, all patients achieved a sustained viral response, regardless of the regimen used. the Homeostatic Model Assessment for Insulin Resistance decreased significantly at the end of treatment; however, when recalculated at week 12 after end of treatment, the reduction of the Homeostatic Model Assessment for Insulin Resistance was not significant compared to the baseline levels. Total cholesterol and low-density lipoproteins increased at the end of treatment and continued to increase for 12 weeks after the end of treatment.
Conclusions
Improvements in insulin resistance and glycemic control were noted in HCV patients at the end of treatment with directly acting antiviral drugs; this effect was also apparent after 12 weeks. An increase in the levels of total cholesterol and low-density lipoprotein can be expected after treatment with directly acting antiviral drugs.
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Carvalhal MMDL, Dias JLL, Gomes DL, Quaresma JAS. Hepatitis C virus eradication on glycemic control and insulin resistance. Rev Assoc Med Bras (1992) 2021; 67:1821-1824. [PMID: 34909956 DOI: 10.1590/1806-9282.20210752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review data regarding the effects of hepatitis C virus eradication on glycemic control and insulin resistance. METHODS This is an integrative literature review, carried out in the PubMed, SciELO, and Lilacs databases. Studies published in the past five years that were fully available, written in English or Portuguese, and have addressed the effects of eradication of the hepatitis C virus on glycemic control and insulin resistance were selected. RESULTS Nine studies were selected. Among the results found, it was observed that there is no consensus on the effects of viral eradication on glycemic control and IR, as some authors show an eventual improvement in insulin resistance and glycemic control, while other studies indicate that there are no significant differences between the parameters evaluated after viral eradication. CONCLUSIONS Although there is a relationship between hepatitis C virus infection and the development of insulin resistance and type 2 diabetes mellitus and recent advances in research, it was observed that there is no consensus on improving insulin resistance and glycemic control after antiviral treatment, probably due to methodological differences between studies. However, it emphasizes the need to guide people diagnosed with hepatitis C, regarding changes in lifestyle, encouragement of multidisciplinary monitoring, and control of other risk factors.
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Lapumnuaypol K, Pisarcik D, Putthapiban P, Sukhumthammarat W, Wijarnpreecha K, Thongprayoon C, Ungprasert P. Direct-acting antiviral agents decrease haemoglobin A1c level in patients with diabetes infected with hepatitis C virus: A systematic review & meta-analysis. Indian J Med Res 2021; 152:562-567. [PMID: 34145095 PMCID: PMC8224154 DOI: 10.4103/ijmr.ijmr_1088_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background & objectives: Several epidemiologic studies have demonstrated that type 2 diabetes mellitus (T2DM) is more prevalent in patients infected with hepatitis C virus (HCV), and the eradication of HCV has been shown to decrease the risk of T2DM. This meta-analysis was undertaken to see if treatment with direct-acting antiviral (DAA) agents would improve glycaemic control among HCV-infected patients with T2DM . Methods: A systematic review was conducted using MEDLINE and EMBASE databases since inception to February 2018. Eligible studies must be cohort studies that recruited HCV-infected patients with T2DM and received DAA therapy. The studies must report the change of haemoglobin A1c (HbA1c) level (before vs. after DAA therapy). Patients who achieved sustained virologic response (SVR) were included in the meta-analysis. The mean HbA1c level and standard deviation of participants were extracted from each study to calculate the mean difference (MD). Pooled MD was then calculated using the random effects model. Results: Four cohort studies with 2648 patients were included. Among HCV-infected T2DM patients who achieved SVR with DAA agents, the mean HbA1c level after treatment was significantly lower than the mean HbA1c level before treatment, with the pooled MD of −0.50 per cent (95% confidence interval, −0.66 to −0.34, I2 = 77%). The main limitation of this study was the lack of comparison groups. Therefore, it could not be concluded that the observed decreased HbA1c level was a direct result of DAA therapy. Interpretation & conclusions: Treatment with DAA agents was found to be associated with a significant reduction of post-treatment HbA1c level compared with pre-treatment HbA1c level among T2DM patients who achieved SVR.
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Affiliation(s)
| | - David Pisarcik
- Department of Internal Medicine, Philadelphia College of Osteopathic Medicine, PA, USA
| | | | | | - Karn Wijarnpreecha
- Department of Gastroenterology, Mayo Clinic Hospital, Gastroenterology - Jacksonville, FL, USA
| | - Charat Thongprayoon
- Department of Nephrology, Mayo Clinic, Nephrology & Hypertension Rochester, MN, USA
| | - Patompong Ungprasert
- Department of Research & Development, Division of Clinical Epidemiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Estefan S, Brandão-Melo CE, Dos Santos Silva CM, Gomes DCK, Cardoso P, Costa MHS. Metabolic Evaluation in Patients With Hepatitis C Treated With Direct Antiviral Agents. Front Med (Lausanne) 2021; 8:631600. [PMID: 34136497 PMCID: PMC8200477 DOI: 10.3389/fmed.2021.631600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
Epidemiological data clearly indicate a link between hepatitis C virus (HCV) and altered glucose homeostasis. Objective: To evaluate the response of treatment with direct antiviral agents (DAAs) on metabolic variables of patients with hepatitis C. Methods: Observational, cross-sectional study in a sample of patients with hepatitis C starting therapy with DAAs followed on the hepatology division of Federal University of Rio de Janeiro State. Data were collected in two stages: before the start of therapy and between 12 and 52 weeks after obtaining the sustained virological response. Results: In the baseline assessment of the 97 patients selected, 19.3% were obese, 38.6% were overweight, 50% were hypertensive, 43.8% were pre-diabetic, 12.5% were diabetic, 31.2% were dyslipidemic, and 21.8% had metabolic syndrome. There was an increase in total cholesterol and LDL levels (p < 0.001), and a non-significant reduction in blood glucose, glycated hemoglobin, insulin, and HOMA-IR levels after treatment. In the post-treatment, there was a reduction in fibrosis (p = 0.016), with a reduction in the levels of GGT, AST, and ALT (all with p < 0.001), as well as in the FIB4 and APRI scores (both with p < 0.001) and in the degree of fibrosis evaluated by elastography represented in kPa (p = 0.006). The blood glucose level was higher in patients with steatosis (p = 0.039) after treatment. There was a positive pre-treatment correlation between the degree of fibrosis (kPa) and FIB4 (r = 0.319, p = 0.004), APRI (r = 0.287, p = 0.010), and the NAFLD score (r = 0.275, p = 0.016). Conclusion: Patients with hepatitis C had a high prevalence of metabolic disturbance in the pre-treatment phase, but the therapy did not show beneficial effects, especially on glucose metabolism.
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Affiliation(s)
- Sergio Estefan
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | | | | | - Danilo Cosme Klein Gomes
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paula Cardoso
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Marcia Helena S Costa
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Shengir M, Elgara M, Sebastiani G. Metabolic and cardiovascular complications after virological cure in hepatitis C: What awaits beyond. World J Gastroenterol 2021; 27:1959-1972. [PMID: 34007133 PMCID: PMC8108037 DOI: 10.3748/wjg.v27.i17.1959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
The association between chronic hepatitis C (CHC) infection and extrahepatic manifestations (EHMs), particularly cardiometabolic diseases, has been extensively examined. However, there has still been insufficient evaluation for these EHMs after virological cure. Several multidirectional mechanisms have been proposed explaining the ability of hepatitis C virus (HCV) developing EHMs, cardiometabolic ones, as well as the effect of antiviral therapy to resolve these EHMs. Data on these manifestations after achieving sustained virologic response (SVR) are still conflicting. However, current evidence suggests that reversal of hepatic steatosis and its coexistent hypocholesterolemia after successful viral eradication led to unfavorable lipid profile, which increases cardiovascular disease (CVD) risk. Additionally, most observations showed that metabolic alterations, such as insulin resistance and diabetes mellitus (DM), undergo some degree of reduction after viral clearance. These changes seem HCV-genotype dependent. Interferon-based antiviral therapy and direct acting antiviral drugs were shown to minimize incidence of DM. Large epidemiological studies that investigated the effect of SVR on CVD showed great discrepancies in terms of results, with predominant findings indicating that CVD events decreased in patients with SVR compared to non-responders or untreated ones. In this review, we present a summary of the current knowledge regarding extrahepatic sequelae of CHC following SVR, which may have an impact on healthcare providers’ clinical practice.
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Affiliation(s)
- Mohamed Shengir
- Department of Medicine, McGill University, Montreal, Quebec H3A0G4, Canada
| | - Mohamed Elgara
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Giada Sebastiani
- Department of Medicine, McGill University Health Center, Montreal, Quebec H4A3J1, Canada
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Sacco M, Saracco GM. The impact of direct-acting antiviral treatment on glycemic homeostasis in patients with chronic hepatitis C. Minerva Gastroenterol (Torino) 2021; 67:264-272. [PMID: 33856147 DOI: 10.23736/s2724-5985.21.02835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND there is robust epidemiological evidence suggesting the link of chronic Hepatitis C Virus (HCV) infection with type 2 diabetes mellitus (DM). Viral clearance achieved by Direct Acting Antiviral Agents (DAAs) has been associated to significant improvements in glycometabolic control but data on the long-term effect of Sustained Virological Response on diabetic disease are limited. AIM the aim of this review is to evaluate the influence of SVR after DAA-based therapy on Insulin Resistance (IR) and DM incidence in non-diabetic patients, on the glycemic homeostasis in diabetic patients and on their long-term hepatic and metabolic outcomes. METHODS an electronic search of Embase, PubMed, MEDLINE, Ovid and the Cochrane Database of Systematic Reviews was performed for papers regarding the effect of DAAinduced SVR on the glycometabolic control and clinical outcomes of HCV-positive diabetic patients up to September 30, 2020. RESULTS among non-diabetic patients, a significant reduction in the risk of IR and DM was reported by the vast majority of the studies; the glycometabolic control significantly improved in diabetic patients during and immediately after the end of antiviral treatment. However, whether this beneficial effect is long lasting is still matter of debate. Furthermore, at variance with data obtained during the Interferon (IFN) era, DM does not seem to be an unfavourable predictive factor of Hepatocellular Carcinoma (HCC) in cured patients. CONCLUSIONS a favourable influence of DAA-induced SVR on IR and DM incidence and on glycemic control is reported by several studies. However, the long-term biochemical, metabolic and clinical impact of this endocrine benefit remains largely unknown.
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Affiliation(s)
- Marco Sacco
- Gastro-hepatoloy Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio M Saracco
- Gastro-hepatoloy Unit, Department of Medical Sciences, University of Turin, Turin, Italy -
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Sagnelli E, Sagnelli C, Russo A, Pisaturo M, Camaioni C, Astorri R, Coppola N. Impact of DAA-Based Regimens on HCV-Related Extra-Hepatic Damage: A Narrative Review. Adv Exp Med Biol 2021; 1323:115-47. [PMID: 33326112 DOI: 10.1007/5584_2020_604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Two-third of patients with chronic hepatitis C show extrahepatic manifestations due to HCV infection of B lymphocytes, such as mixed cryoglobulinemia and non-Hodgkin B-cell lymphoma, or develop a chronic inflammatory status that may favor the development of adverse cardiovascular events, kidney diseases or metabolic abnormalities.DAAs treatments induce HCV eradication in 95% of treated patients, which also improves the clinical course of extrahepatic manifestations, but with some limitations. After HCV eradication a good compensation of T2DM has been observed, but doubts persist about the possibility of obtaining a stable reduction in fasting glucose and HbA1c levels.Chronic HCV infection is associated with low total and LDL cholesterol serum levels, which however increase significantly after HCV elimination, possibly due to the disruption of HCV/lipid metabolism interaction. Despite this adverse effect, HCV eradication exerts a favorable action on cardiovascular system, possibly by eliminating numerous other harmful effects exerted by HCV on this system.DAA treatment is also indicated for the treatment of patients with mixed cryoglobulinemia syndrome, since HCV eradication results in symptom reduction and, in particular, is effective in cryoglobulinemic vasculitis. Furthermore, HCV eradication exerts a favorable action on HCV-related lymphoproliferative disorders, with frequent remission or reduction of clinical manifestations.There is also evidence that HCV clearance may improve impaired renal functions, but same conflicting data persist on the effect of some DAAs on eGFR.
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12
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Ciancio A, Ribaldone DG, Dotta A, Giordanino C, Sacco M, Fagoonee S, Pellicano R, Saracco GM. Long-term follow-up of diabetic and non-diabetic patients with chronic hepatitis C successfully treated with direct-acting antiviral agents. Liver Int 2021; 41:276-287. [PMID: 32998174 DOI: 10.1111/liv.14676] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Clearance of hepatitis C virus (HCV) is associated with improved glycometabolic control in patients with diabetes mellitus (DM) but whether this effect is maintained over the long term with a reduction in liver-related events (LRE) is still debated. To address these issues, we conducted a long-term prospective study on diabetic and non-diabetic patients with chronic hepatitis C cured by direct antiviral agents (DAAs). METHODS Among 893 recruited patients, 15.7% were diabetic (Group 1) and 84.3% non-diabetic (Group 2); changes in fasting glucose (FG) and glycated haemoglobin (HbA1c) levels were assessed in Group 1 while the incidence of LRE was established in the whole cohort. Differences between groups were evaluated and independent predictors of unfavourable clinical outcome were established. RESULTS After a mean follow up of 44.5 months, a significant reduction in FG and HbA1c values was found in Group 1. Death was reported in 5.7% of patients in Group 1 vs 1.6% in Group 2 (P = .003), hepatocellular carcinoma (HCC)-free survival was significantly lower in Group 2 (P = .015) as well as LRE-free survival in Group 1 cirrhotic patients (P = .0006). After adjustment for baseline variables, cirrhosis and albumin levels emerged as independent predictors of LRE; low albumin levels, DM and central obesity were associated with HCC risk in cirrhotic patients while insulin therapy emerged as unfavourable predictor among diabetics. CONCLUSIONS SVR achieved by DAAs is associated with long-term improvement of glycometabolic control in diabetic patients, but among cirrhotics DM still exerts a detrimental effect on the liver.
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Affiliation(s)
- Alessia Ciancio
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide G Ribaldone
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Dotta
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Giordanino
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Sacco
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging (CNR) c/o Molecular Biotechnology Center, Turin, Italy
| | - Rinaldo Pellicano
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio M Saracco
- Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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Strauhs-Nitsch L, Campiolo MF, Morsoletto DBG, Pissaia Junior A, Ivantes CAP. CURING HEPATITIS C WITH THE NEW DIRECT ACTING ANTIVIRALS DID NOT IMPROVE INSULIN RESISTANCE AFTER ONE YEAR. Arq Gastroenterol 2021; 57:267-271. [PMID: 33027477 DOI: 10.1590/s0004-2803.202000000-50] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/30/2020] [Indexed: 01/10/2023]
Abstract
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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Affiliation(s)
- Lohanna Strauhs-Nitsch
- Hospital Nossa Senhora das Graças, Departamento de Gastroenterologia e Hepatologia, Curitiba, PR, Brasil
| | - Marcela Ferro Campiolo
- Hospital Nossa Senhora das Graças, Departamento de Gastroenterologia e Hepatologia, Curitiba, PR, Brasil
| | | | - Alcindo Pissaia Junior
- Hospital Nossa Senhora das Graças, Departamento de Gastroenterologia e Hepatologia, Curitiba, PR, Brasil
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Chiu HC, Chiu YC, Yang EH, Chang TT, Chien SC, Wu IC, Wu CH, Cheng PN. Effectiveness and safety of ledipasvir/sofosbuvir for genotype 2 chronic hepatitis C infection: Real-world experience from Taiwan. J Formos Med Assoc 2020; 120:983-990. [PMID: 32891488 DOI: 10.1016/j.jfma.2020.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/27/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/PURPOSE Genotype 2 (GT2) hepatitis C virus infection is the second common genotype in Taiwan. Real-world experience of ledipasvir/sofosbuvir (LDV/SOF) for GT2 infection is limited. The aim of this study is to evaluate the effectiveness and safety of LDV/SOF in patients with GT2 chronic hepatitis C (CHC) infection. METHODS CHC patients with GT2 infection receiving 12 weeks LDV/SOF from three hospitals were enrolled. HCV RNA was checked at baseline, end-of-treatment and 12 weeks after completing treatment. Demographic data, adverse events, renal function and metabolic profiles were recorded. RESULTS Among 392 enrolled patients, 33 patients (8.4%) were cirrhotic. Sustained virological response (SVR) rate was 96.7% (379/392) by intention-to-treat analysis and 97.2% (379/390) by per-protocol analysis. The SVR rate was lower in cirrhotic patients than in non-cirrhotic patients (90.6% vs 97.8%, p = 0.053). Two cirrhotic patients who took LDV/SOF plus ribavirin both achieved SVR. Neither drug-related severe adverse events nor discontinuation due to drug-related adverse event were reported. The estimated glomerular filtration rate (eGFR) remained stable in patients with chronic kidney disease 3a/3b. CONCLUSION Twelve weeks of LDV/SOF treatment provided an excellent and safe regimen for GT2 CHC infection, particularly in non-cirrhotic patients.
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Affiliation(s)
- Hung-Chih Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Cheng Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Er-Hsiang Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Tsung Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chieh Chien
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Chin Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsien Wu
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Graf C, Welzel T, Bogdanou D, Vermehren J, Beckel A, Bojunga J, Friedrich-Rust M, Dietz J, Kubesch A, Mondorf A, Fischer S, Lutz T, Stoffers P, Herrmann E, Poynard T, Zeuzem S, Dultz G, Mihm U. Hepatitis C Clearance by Direct-Acting Antivirals Impacts Glucose and Lipid Homeostasis. J Clin Med 2020; 9:E2702. [PMID: 32825571 PMCID: PMC7564474 DOI: 10.3390/jcm9092702] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infections are causally linked with metabolic comorbidities such as insulin resistance, hepatic steatosis, and dyslipidemia. However, the clinical impact of HCV eradication achieved by direct-acting antivirals (DAAs) on glucose and lipid homeostasis is still controversial. The study aimed to prospectively investigate whether antiviral therapy of HCV with DAAs alters glucose and lipid parameters. METHODS 50 patients with chronic HCV who were treated with DAAs were screened, and 49 were enrolled in the study. Biochemical and virological data, as well as noninvasive liver fibrosis parameters, were prospectively collected at baseline, at the end of treatment (EOT) and 12 and 24 weeks post-treatment. RESULTS 45 of 46 patients achieved sustained virologic response (SVR). The prevalence of insulin resistance (HOMA-IR) after HCV clearance was significantly lower, compared to baseline (5.3 ± 6.1 to 2.5 ± 1.9, p < 0.001), which is primarily attributable to a significant decrease of fasting insulin levels (18.9 ± 17.3 to 11.7 ± 8.7; p = 0.002). In contrast to that, HCV eradication resulted in a significant increase in cholesterol levels (total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein (HDL-C) levels) and Controlled Attenuated Score (CAP), although BMI did not significantly change over time (p = 0.95). Moreover, HOMA-IR correlated significantly with noninvasive liver fibrosis measurements at baseline und during follow-up (TE: r = 0.45; p = 0.003, pSWE: r = 0.35; p = 0.02, APRI: r = 0.44; p = 0.003, FIB-4: r = 0.41; p < 0.001). CONCLUSION Viral eradication following DAA therapy may have beneficial effects on glucose homeostasis, whereas lipid profile seems to be worsened.
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Affiliation(s)
- Christiana Graf
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Tania Welzel
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Dimitra Bogdanou
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Johannes Vermehren
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Anita Beckel
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Jörg Bojunga
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Mireen Friedrich-Rust
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Julia Dietz
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Alica Kubesch
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Antonia Mondorf
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Sarah Fischer
- Infektiologikum, Center for Infectious Diseases, 60596 Frankfurt, Germany; (S.F.); (T.L.)
| | - Thomas Lutz
- Infektiologikum, Center for Infectious Diseases, 60596 Frankfurt, Germany; (S.F.); (T.L.)
| | - Philipp Stoffers
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, 60596 Frankfurt, Germany;
| | | | - Stefan Zeuzem
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Georg Dultz
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Ulrike Mihm
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
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Ribaldone DG, Sacco M, Saracco GM. The Effect of Viral Clearance Achieved by Direct-Acting Antiviral Agents on Hepatitis C Virus Positive Patients with Type 2 Diabetes Mellitus: A Word of Caution after the Initial Enthusiasm. J Clin Med. 2020;9. [PMID: 32092892 PMCID: PMC7074145 DOI: 10.3390/jcm9020563] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
The causal link between chronic hepatitis C and glycometabolic alterations has been confirmed by much biochemical, clinical, and epidemiological research work, but what is still controversial is the long-term clinical impact of sustained virologic response (SVR) achieved by direct-acting antiviral agents (DAAs) on patients with type 2 diabetes mellitus (DM). The aim of this paper is to summarize the biochemical and clinical consequences to DM of DAA-based therapy for hepatitis C virus (HCV) infection. An electronic search of Embase, PubMed, MEDLINE, Ovid, and the Cochrane Database of Systematic Reviews was conducted for publications assessing whether clearance of HCV achieved by interferon (IFN)-free antiviral therapy determines significant changes in glycometabolic control and clinical outcomes of diabetic patients. A beneficial effect of SVR obtained by DAA therapy on DM prevention and the short-term outcome of glycometabolic alterations are acknowledged by most of the studies. Whether this effect is maintained over the long term with a significant clinical impact on diabetic and liver disease is still a matter of debate.
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17
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Mada PK, Malus ME, Parvathaneni A, Chen B, Castano G, Adley S, Moore M, Hieda M, Alam MJ, Feldman M, King JW. Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus. Int J Hepatol 2020; 2020:6438753. [PMID: 32395351 DOI: 10.1155/2020/6438753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
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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Niccum BA, Stine JG, Wynter JA, Kelly V, Caldwell SH, Shah NL. Success of Direct-Acting, Antiviral-Based Therapy for Chronic Hepatitis C Is Not Affected by Type 2 Diabetes. Clin Diabetes 2020; 38:40-46. [PMID: 31975750 PMCID: PMC6969670 DOI: 10.2337/cd18-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic hepatitis C virus (HCV) is a risk factor for type 2 diabetes. In the era of interferon-based HCV therapy, type 2 diabetes was associated with decreased likelihood of sustained virologic response (SVR). Preliminary studies suggest that type 2 diabetes may not reduce the efficacy of regimens involving direct-acting antiviral (DAA) medications. We aimed to determine whether preexisting type 2 diabetes is associated with a reduced rate of SVR achieved 12 weeks after treatment of HCV with DAA-based regimens.
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Affiliation(s)
- Blake A. Niccum
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Javelle A. Wynter
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Virginia Kelly
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Stephen H. Caldwell
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Neeral L. Shah
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
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Gilad A, Fricker ZP, Hsieh A, Thomas DD, Zahorian T, Nunes DP. Sustained Improvement in Type 2 Diabetes Mellitus is Common After Treatment of Hepatitis C Virus With Direct-acting Antiviral Therapy. J Clin Gastroenterol 2019; 53:616-20. [PMID: 30614943 DOI: 10.1097/MCG.0000000000001168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
GOALS To determine whether diabetic patients with hepatitis C virus (HCV) treated with direct-acting antiviral agents have improved diabetes, accounting for change in both hemoglobin A1c (HbA1c) and diabetes medications, and whether any improvement was sustained. BACKGROUND HCV infection is associated with an increased risk of diabetes, with improvement in glycemic control after eradication. There remains uncertainty about the durability and magnitude of this effect. STUDY HbA1c and diabetes medications were recorded at 6-month intervals for 1.5 years pretreatment and posttreatment for 122 patients. Subjects were classified as having improved diabetes if there was a decrease in HbA1c≥0.5% with no increase in diabetes medications or a decrease in diabetes medications with a stable HbA1c. RESULTS HbA1c at the nearest time point before treatment was 8.4%±1.9%, compared with 7.8%±1.7% after treatment, a mean difference of 0.6% [95% CI (0.2, 0.9), P<0.01]. A linear mixed effects model incorporating each subject's repeated measurements over time also demonstrated a reduction after treatment of 0.5% [95% CI, (0.3, 0.8), P<0.001]. Accounting for both HbA1c and diabetes medications, 42 of 122 (34%) had an improvement in diabetes after HCV treatment, and 20 of 28 (71%) of these subjects sustained improvement at 1.5 years follow-up. Prescription of insulin was associated with improved diabetes. CONCLUSIONS Treatment of HCV with direct-acting antiviral agents was associated with improved diabetes in a significant portion of patients with an average reduction in HbA1c of clinically significant magnitude. Among responders, this effect was sustained over 1.5 years of follow-up.
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Carnovale C, Gentili M, Magni C, Mazhar F, Mosini G, Clementi E, Radice S. The impact of a successful treatment of HCV on glyco-metabolic control in diabetic patients. Antivir Ther 2019; 24:147-149. [PMID: 30835253 DOI: 10.3851/imp3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Carlo Magni
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy.,Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
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Rife K, Lyman A, LeClerc-Kamieniecki S, Falck-Ytter C, Pascuzzi K, Burant CJ, Falck-Ytter Y. Significant HbA 1c Lowering in Patients Achieving a Hepatitis C Virus Cure. Fed Pract 2019; 36:S26-S32. [PMID: 30983858 PMCID: PMC6453605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The immediate clinically significant reduction in hemoglobin A1c following HCV treatment observed in this study contrasts with the expected rise seen with normal disease progression.
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Affiliation(s)
- Kelsey Rife
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
| | - Alessandra Lyman
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
| | - Sheena LeClerc-Kamieniecki
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
| | - Corinna Falck-Ytter
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
| | - Kristina Pascuzzi
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
| | - Christopher J Burant
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
| | - Yngve Falck-Ytter
- , and are Clinical Pharmacy Specialists; is the Section Chief of Primary Care, is a Statistician in the Geriatric Research, Education, and Clinical Center; and is the Section Chief of Gastroenterology and Hepatology; all at the VA Northeast Ohio Healthcare System in Cleveland. is a Clinical Pharmacy Specialist at the Chillicothe Veterans Affairs Medical Center in Ohio. Corinna Falck-Ytter is an Associate Professor of Medicine, Christopher Burant is an Associate Professor of Nursing, and Yngve Falck-Ytter is a Professor of Medicine, all at Case Western Reserve University in Cleveland, Ohio
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Carnovale C, Pozzi M, Dassano A, D'Addio F, Gentili M, Magni C, Clementi E, Radice S, Fiorina P. The impact of a successful treatment of hepatitis C virus on glyco-metabolic control in diabetic patients: a systematic review and meta-analysis. Acta Diabetol 2019; 56:341-354. [PMID: 30478781 DOI: 10.1007/s00592-018-1257-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023]
Abstract
AIMS The effect of HCV eradication following the use of direct-acting antiviral drugs (DAAs) on the glyco-metabolic control is unknown. Through a meta-analysis of available clinical studies, we investigated whether eradication of HCV infection with interferon-free DAAs is associated with improved glyco-metabolic control in diabetic patients. METHODS We searched the PubMed, MEDLINE and Embase, up to 08th June 2018, for all studies evaluating whether eradication of HCV infection with DAAs is associated with changes in glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) levels from baseline in human subjects, without restrictions for study type and language. Data were independently extracted by two researchers using pre-specified forms. Random effects meta-analyses were conducted on HbA1c and FPG levels before/after HCV eradication. RESULTS We found a significant mean reduction in HbA1c levels of - 0.45% (95% CI - 0.60 to - 0.30%; P < 0.001) and in FPG levels of - 22.03 mg/dL (95% CI - 41.61 to - 2.44 mg/dL; P = 0.03), with high heterogeneity between studies (χ2 = 20.4, P < 0.001, I2 = 80% and χ2 = 35.8, P = 0.001, I2 = 94%, respectively). The number of available manuscripts did not allow conducting a meta-regression to elucidate the role of sustained virological response and other confounders in determining the effect of direct-acting antiviral agents on HbA1c reduction. CONCLUSIONS We found a significant improvement in glyco-metabolic control after HCV eradication (in terms of glycated haemoglobin and fasting plasma glucose levels reduction) following direct-acting antiviral treatment in patients with established diabetes, including a consequent positive impact on anti-diabetic therapies.
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Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842, Bosisio Parini, Lecco, Italy
| | - Alice Dassano
- International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, Università di Milano, 20157, Milan, Italy
| | - Francesca D'Addio
- International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, Università di Milano, 20157, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Carlo Magni
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
- Scientific Institute IRCCS Eugenio Medea, 23842, Bosisio Parini, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Paolo Fiorina
- International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, Università di Milano, 20157, Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
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24
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Affiliation(s)
- Leonardo de Lucca Schiavon
- Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina. Brasil
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Yang A, Ju W, Yuan X, Han M, Wang X, Guo Z, Wei X, Wang D, Zhu X, Wu L, He X. Comparison between liver resection and liver transplantation on outcomes in patients with solitary hepatocellular carcinoma meeting UNOS criteria: a population-based study of the SEER database. Oncotarget 2017; 8:97428-97438. [PMID: 29228622 PMCID: PMC5722574 DOI: 10.18632/oncotarget.22134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/27/2017] [Indexed: 02/06/2023] Open
Abstract
Liver resection (LR) and liver transplantation (LT) are potential curative treatment methods for early hepatocellular carcinoma (HCC). However, it is controversial which treatment is more beneficial to patients with solitary HCC meeting the United Network for Organ Sharing (UNOS) criteria (single lesion, diameter≤50mm, no vascular invasion, no extrahepatic metastasis). We retrieved patients with solitary HCC meeting UNOS criteria diagnosed between 2004-2013 from the Surveillance Epidemiology and End Results (SEER) database. Multivariate Cox proportional hazards regression models were used to evaluate the impact of surgery type (LR/LT) on overall survival (OS) and disease-specific survival (DSS) in both the whole study group and subgroups. Our analyses show that LT Patients had significantly superior OS (Adjusted HR (95% CI): 0.39 [0.26-0.59]) and DSS (Adjusted HR (95% CI): 0.19 [0.10-0.35]) than those receiving LR, although compared with the 288 patients receiving LR, the 258 patients receiving LT had younger age, smaller tumor size, and higher fibrosis score (P<0.001). Subgroup analyses identified significant interactions between surgery type (LR/LT) and gender (Male/Female) in both OS (P=0.02) and DSS (P=0.02). Male patients benefit more from LT compared with LR in both OS (Adjusted HR (95% CI): 0.29 [0.18-0.47]) and DSS (Adjusted HR (95% CI): 0.10 [0.05-0.21]), but there is no difference between patients receiving LT and LR in female patients. In conclusion, LT is associated with superior survival than LR in patients with solitary HCC meeting UNOS criteria. Moreover, male patients benefits more from LT than LR, while female patients do not show different outcomes between the two procedures.
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Affiliation(s)
- Anli Yang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaopeng Yuan
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ming Han
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoping Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoli Wei
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Dongping Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Linwei Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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