Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 28, 2016; 8(30): 1269-1278
Published online Oct 28, 2016. doi: 10.4254/wjh.v8.i30.1269
Retrospective study of the associations between hepatitis C virus infection and metabolic factors
Shira Yair-Sabag, Elchanan Nussinson, Ofir Ben-Assuli, Fahmi Shibli, Azmi Shahbari, Shira Zelber-Sagi
Shira Yair-Sabag, Elchanan Nussinson, Fahmi Shibli, Azmi Shahbari, Gastroenterology Institute, Emek Medical Center, Afula 18742, Israel
Shira Yair-Sabag, Shira Zelber-Sagi, School of Public Health, University of Haifa, Haifa 3498838, Israel
Ofir Ben-Assuli, Ono Academic College, Kiryat Ono 5545173, Israel
Author contributions: Yair-Sabag S performed the research and drafted and wrote the paper; Yair-Sabag S, Nussinson E and Zelber-Sagi S contributed equally to this manuscript; Nussinson E wrote the paper and supervised the study; Ben-Assuli O provided analytical oversight; Shibli F and Shahbari A provided administrative support; Zelber-Sagi S designed and supervised the study.
Institutional review board statement: This study was reviewed and approved by the Haifa University and Emek Medical Center Institutional Review Boards.
Informed consent statement: All study participants provided verbal informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to declare.
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:
Correspondence to: Elchanan Nussinson, MD, Gastroenterology Institute, Emek Medical Center, Duchifat 7 St, Afula 18742, Israel.
Telephone: +972-54-4943922 Fax: +972-4-6523745
Received: May 8, 2016
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.

Keywords: Hepatitis C virus, Type 2 diabetes mellitus, Antiviral therapy, Sustained viral response, Metabolic syndrome, Hepatic steatosis, Peg interferon alpha, Ribavirin, Direct acting antiviral agents

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.