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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Metabolic syndrome does not affect sustained virologic response of direct-acting antivirals while hepatitis C clearance improves hemoglobin A1c
Tien S Dong, Elizabeth S Aby, Jihane N Benhammou, Jenna Kawamoto, Steven-Huy Han, Folasade P May, Joseph R Pisegna
Tien S Dong, Elizabeth S Aby, Jihane N Benhammou, Folasade P May, Joseph R Pisegna, the Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Department of Medicine, University of California David Geffen School of Medicine, Los Angeles, CA 90095, United States
Tien S Dong, Jihane N Benhammou, Jenna Kawamoto, Steven-Huy Han, Folasade P May, Joseph R Pisegna, Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
Steven-Huy Han, the Pfleger Liver Institute, Department of Surgery, University of California David Geffen School of Medicine, Los Angeles, CA 90095, United States
Folasade P May, VA Health Services Research and Development Center for the Study of Healthcare Innovation Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA 90073, United States
Folasade P May, Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, United States
Author contributions: Dong TS, Aby ES, Benhammou JN, Kawamoto J, Han SH, May FP and Pisegna JR contributed to the project design and writing of the manuscript; Dong TS, Aby ES and Benhammou JN collected data; Dong TS and May FP along with aid from the biostatistical department at UCLA performed the statistics.
Institutional review board statement: This study was approved by the VA Institutional Review Board and the Research and Development Committee at VA Greater Los Angeles Health System (VAGLAHS). ID Number 2016-100938.
Informed consent statement: Due to the retrospective nature of this study, an exempt for informed consent was approved by the VA institutional review board. ID Number 2016-100938.
Conflict-of-interest statement: All authors declare no conflicts of interest that might compromise the integrity of this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tien S Dong, MD, Academic Fellow, the Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Department of Medicine, University of California David Geffen School of Medicine, 10945 Le Conte Ave, PVUB 2114 MC694907, Los Angeles, CA 90095, United States. tsdong@mednet.ucla.edu
Telephone: +1-310-2060449 Fax: +1-310-2671861
Received: April 5, 2018
Peer-review started: April 7, 2018
First decision: May 7, 2018
Revised: May 9, 2018
Accepted: May 23, 2018
Article in press: May 24, 2018
Published online: September 27, 2018
AIM
To determine whether successful treatment with directacting antivirals (DAA) is associated with improvements in hemoglobin A1c (HbA1c) and if type 2 diabetes mellitus (T2DM) or metabolic syndrome affects sustained virologic response (SVR).
METHODS
We performed a retrospective analysis of all hepatitis C virus (HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment (SVR12).
RESULTS
A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2DM. Within that cohort, patients who achieved SVR12 had lower mean HbA1c pre treatment (7.35 vs 8.60, P = 0.02), and lower mean HbA1c post-treatment compared to non-responders (6.55 vs 8.61, P = 0.01). The mean reduction in HbA1c after treatment was greater for those who achieved SVR12 than for non-responders (0.79 vs 0.01, P = 0.03). In adjusted models, patients that achieved SVR12 were more likely to have a HbA1c decrease of ≥ 0.5 than those that did not achieve SVR12 (adjusted OR = 7.24, 95%CI: 1.22-42.94).
CONCLUSION
In HCV patients with T2DM, successful treatment with DAA was associated with a significant reduction in HbA1c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore, the presence of T2DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.
Core tip: The relationship of chronic hepatitis C virus (HCV) and type 2 diabetes mellitus is complex and lesser is known about its relationship to metabolic syndrome. While metabolic syndrome and type 2 diabetes may have had negative outcomes during the era of pegylated-interferon, research is being actively pursued to understand how direct acting antivirals (DAA) may affect these comorbidities. In this study, we show that unlike with pegylated-interferon, direct active antiviral success rates are not affected by the presence of metabolic syndrome. We further show that successful treatment of HCV with DAAs actually leads to better glycemic control 1-year post-treatment.
