Insulin Resistance in HCV May Be Reversed With DAAs

Hepatitis C (HCV) is associated with insulin resistance, and elimination of the virus may help re-establish glycemic control in affected patients, according to a prospective case-control study published in the Journal of Gastroenterology and Hepatology.

Investigators enrolled consecutive patients with HCV and advanced liver fibrosis who were being considered for direct-acting antiviral (DAA) medication (N=133). Researchers evaluated patients treated with DAAs (n=68) and untreated patients (n=65). At baseline, all patients were free of insulin resistance and type 2 diabetes.

At baseline, insulin resistance was 52.3% and 53.8% in treated and untreated patients, respectively. Various DAA treatments were used, including simeprevir + sofosbuvir (43%), ombitasvir/paritaprevir/ritonavir + dasabuvir (45%), and ledipasvir/sofosbuvi (12%). All patients had cleared their HCV at 3-month follow-up, with 95.6% of patients achieving a sustained virologic response.

Approximately 76.5% of patients who achieved a sustained virologic response experienced improvements in insulin resistance. There was a significant 2.42±1.85 point reduction in insulin resistance as assessed by the homeostatic model assessment insulin resistance (HOMA-IR) test (P <.001). Eradication of HCV was also associated with improved insulin sensitivity and decreases in serum blood glucose and insulin. Patients presenting with a high degree of fibrosis at baseline, however, maintained some level of insulin resistance following treatment (P <.04).

The relatively small number of patients included in this analysis prohibits establishing conclusive evidence on the true benefits associated of HCV treatment on reducing insulin resistance.

In addition to the main findings, the investigators also found that the body mass index (BMI) of patients remained unchanged following treatment, suggesting “that the changes in insulin resistance were independent of BMI [and] further supporting the role of HCV-genotype 1 in the development of insulin resistance.”

Disclosure: Luigi Elio Adinolfi, MD, has received honoraria for speaker, travel grants, or advisory board from AbbVie.

Reference

Adinolfi LE, Nevola R, Guerrera B, et al. HCV clearance by direct-acting antiviral treatments reverses insulin resistance in chronic hepatitis C patients [published online December 11, 2017]. J Gastroenterol Hepatol. doi:10.1111/jgh.14067