Published online Oct 28, 2016. doi: 10.4254/wjh.v8.i30.1269
Peer-review started: May 9, 2016
First decision: June 13, 2016
Revised: July 28, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: October 28, 2016
To evaluate the bidirectional association between metabolic syndrome (MS) components and antiviral treatment response for chronic hepatitis C virus (HCV) infection.
This retrospective cohort study included 119 HCV + patients treated with pegylated-interferon-α and ribavirin. Metabolic characteristics and laboratory data were collected from medical records. Differences in baseline clinical and demographic risk factors between responders and non-responders were assessed using independent samples t-tests or χ2 tests. The effects of sustained viral response (SVR) to antiviral treatment on de novo impairments in MS components, including impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM), were assessed using univariable and multivariable logistic regression analysis, while the effect of MS components on SVR was assessed using univariable logistic regression analysis.
Of the 119 patients, 80 (67%) developed SVR over the average 54 ± 13 mo follow-up. The cumulative risks for de novo T2DM and IFG were 5.07- (95%CI: 1.261-20.4, P = 0.022) and 3.87-fold higher (95%CI: 1.484-10.15, P = 0.006), respectively for non-responders than responders, when adjusted for the baseline risk factors age, sex, HCV genotype, high viral load, and steatosis. Post-treatment triglyceride levels were significantly lower in non-responders than in responders (OR = 0.27; 95%CI: 0.069-0.962, P = 0.044). Age and HCV genotype 3 were significantly different between responders and non-responders, and MS components were not significantly associated with SVR. Steatosis tended to attenuate SVR (OR = 0.596; 95%CI: 0.331-1.073, P = 0.08).
SVR was associated with lower de novo T2DM and IFG incidence and higher triglyceride levels. Patients infected with HCV should undergo T2DM screening and antidiabetic treatment.
Core tip: Hepatitis C virus (HCV) is associated with a unique metabolic syndrome (MS) type: Insulin resistance with type 2 diabetes mellitus (T2DM), hypocholesterolemia, and liver steatosis. We retrospectively investigated the association between MS components and HCV infection, including antiviral therapy response, for 119 patients infected with HCV treated with interferon alpha and ribavirin. After long-term follow-up, de novo T2DM incidence significantly decreased, and triglyceride levels significantly increased in treatment responders. Only steatosis tended to affect treatment response. The association between HCV and lipid metabolic pathways may be important even with new direct antiviral agents. Patients infected with HCV should be screened for T2DM.