Long-term follow-up of diabetic and non-diabetic patients with chronic hepatitis C successfully treated with direct-acting antiviral agents(145 views) Ciancio A, Ribaldone DG, Dotta A, Giordanino C, Sacco M, Fagoonee S, Pellicano R, Saracco GM
Liver Int (ISSN: 1478-3223linking), 2021 Feb; 41(2): 276-287.
Keywords: Chronic Hepatitis C, Cirrhosis, Diabetes Mellitus, Direct-Acting Antiviral Agents, Hepatitis C Virus, Insulin Resistance, Antiviral Agents Therapeutic Use
, Carcinoma, Hepatocellular Drug Therapy
, Diabetes Mellitus Drug Therapy Epidemiology
, Follow-Up Studies
, Chronic Complications Drug Therapy
, Humans
, Liver Cirrhosis Drug Therapy
, Liver Neoplasms Drug Therapy
, Prospective Studies,
Affiliations: *** IBB - CNR ***
Gastro-Hepatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
Institute of Biostructure and Bioimaging (CNR) c/o Molecular Biotechnology Center, Turin, Italy.
References: Not available.
Long-term follow-up of diabetic and non-diabetic patients with chronic hepatitis C successfully treated with direct-acting antiviral agents
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.
Long-term follow-up of diabetic and non-diabetic patients with chronic hepatitis C successfully treated with direct-acting antiviral agents