Effect of sustained virological response to treatment on the incidence of abnormal glucose values in chronic hepatitis C (original) (raw)
Related papers
2010
Background/Aims: Impaired fasting glucose is independently associated with reduced likelihood of SVR with current therapy (NEJM, 2009;361:580). However, the relationship between SVR, fasting blood glucose (FBG) and HBA1c has not been defined. Methods: 3070 treatment-naive, CHC genotype 1 patients (pts) received peginterferon (PegIFN) alfa-2b or alfa-2a plus ribavirin (RBV). All pts underwent pretreatment FBG determination and were categorized by their medical history of diabetes. Based on American Diabetes Association definition, pts with FBG ≥100mg/dL were defined as having impaired fasting glucose (IFG). Per protocol, pts with known diabetes and/or FBG ≥116mg/dL underwent HBA1c testing; those with HBA1c >8.5% were excluded. Pts with FBG between 100 and 115mg/dL did not have HBA1c testing. Virologic response rates were analyzed. Results: 3068 pts were included in the analysis. The frequency of IFG of ≥100mg/dL was 28.7% (880/3068) and of a medical history of diabetes was 6.7% (206/3068). Among those who underwent testing (n=324), median HBA1c was 6.1% (interquartile range 5.6%-6.6%). SVR according to baseline FBG for all pts and according to HBA1c for the subset with testing are shown (Table). SVR rate was significantly lower among pts with IFG compared to those with FBG <100mg/dL (P<0.001); relapse rate was also higher in those with IFG. Pts with a history of diabetes had lower SVR rates than those without (21.4% [44/206] vs 41.0% [1161/2833]). However, among those tested, the SVR rate was not associated with HBA1c level (<6% vs ≥6%; P=0.88). Conclusions: Impaired fasting glucose and the clinical diagnosis of diabetes were each strongly associated with lower SVR and higher relapse rates in CHC genotype 1 pts treated with PegIFN/RBV. Among those who underwent testing, no association between HBA1c level and SVR was apparent; however, pts with HBA1c >8.5% were excluded from treatment. These data suggest that FBG should be routinely assessed prior to therapy; randomized trials are needed to determine if improvement in glucose control prior to treatment will lead to improved viral response. SVR (%) EOT Response (%) Relapse (%) Fasting Blood Glucose (pretreatment) All Pts (n=3068) 40 56 26 <100 mg/dL (n=2188) 43 58 22 100-125 mg/dL (n=747) 31 50 34 >125 mg/dL (n=133) 25 44 40 HBA1c (pretreatment) Pts with protocol-defined criteria of diabetes and/or FBG ≥116mg/dL (n=324) 26 45 40 <6% (n=139) 25 45 44 6-<7% (n=133) 23 46 46 7-8.5% (n=52) 33
Clinical Significance of Metabolic Syndrome in the Setting of Chronic Hepatitis C Virus Infection
Clinical Gastroenterology and Hepatology, 2008
unique condition in which the underlying mechanism is related to insulin resistance. In hepatitis C virus (HCV) patients, insulin resistance has been linked to treatment failure. The aim of this study was to estimate the prevalence of MS in HCV patients undergoing antiviral therapy and to assess its predictive value in treatment outcome. Methods: All HCV treatment-naive patients who met the inclusion/ exclusion criteria were studied (n ؍ 228). MS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A logistic regression analysis was performed to study multivariable associations. The final model contained sex, ethnicity, body mass index, viral load, genotype, steatosis, fibrosis stage, and MS. Results: MS was present in 59 of 228 (26%) patients. Genotype 1 (P ؍ .002) and presence of steatosis (P < .001) were found to be associated significantly with MS. Overall, sustained virologic response (SVR) was achieved in 108 of 228 (47%) patients. Male sex, non-Caucasian ethnicity, higher body mass index, high viral load, genotype 1, higher fibrosis stage, and MS were associated significantly with a lack of SVR. After adjusting for confounding variables, MS remained independently associated with a lack of SVR (P < .01). Specifically, subjects with MS were 3.8 (95% confidence interval, 1.4 -10.5) times more likely to fail treatment than those without MS. Conclusions: MS is seen frequently in patients with chronic HCV and is associated independently to lack of SVR. These findings support the concept that an aggressive intervention approach comprising lifestyle modification alone or in combination with drug treatment of the MS components may play an important role in improving antiviral responses in these patients.
Metabolic Impact of Diabetes Mellitus Type 2 in Hepatitis C Virus Infected Patients
Current Health Sciences Journal, 2021
Objective: Patients with chronic hepatitis C are subjected to a greater risk of cardiovascular disease and difficult to control diabetes mellitus type 2 (T2DM) comparatively to people that have never contracted Hepatitis C Virus (HCV). We aimed to investigate the impact of T2DM on HCV patients with the help of Fibromax test results compared to nonT2DM patients, and the metabolic differences between the 2 study groups. Our long term goals are to observe the long term impact of achieving systemic virusologic response (SVR) by means of Direct-Acting antivirals (DAA) between the 2 cohorts. Research Design and Methods: We selected a lot of 200 patients with HCV that will undergo interferon-free DAA-based antiviral treatment for HCV and we used the results of the Fibromax Test to compare the biological parameters of T2DM and nonT2DM patients. RESULTS Among patients with T2DM compared to NonT2DM there is a significant correlation on Steatotest, NashTest, GGT, Glycemia, body weight, height ...
High Prevalence of Glucose Abnormalities in Patients With Hepatitis C Virus Infection
Diabetes Care, 2004
OBJECTIVE—The aim of this study was to compare the prevalence of both impaired fasting glucose (IFG) and diabetes between hepatitis C virus (HCV)-infected patients and patients with other liver diseases but anti-HCV−, taking into account the degree of liver damage. RESEARCH DESIGN AND METHODS—A total of 642 consecutive patients attending the outpatient liver unit of a university hospital (498 anti-HCV+ and 144 anti-HCV−) were prospectively recruited. Patients were classified as having chronic hepatitis (n = 472) or cirrhosis (n = 170) by means of the result of either a liver biopsy or by typical clinical features. A logistic regression model was used to determine independent associations of covariates (age, sex, BMI, HCV antibody status, and triglycerides) with the presence of glucose abnormalities. RESULTS—A threefold increase in the prevalence of glucose abnormalities was observed in HCV+ patients with chronic hepatitis in comparison with HCV− subjects (32 vs. 12%; P = 0.0003). In...
Retrospective study of the associations between hepatitis C virus infection and metabolic factors
World Journal of Hepatology, 2016
AIM To evaluate the bidirectional association between metabolic syndrome (MS) components and antiviral treatment response for chronic hepatitis C virus (HCV) infection. METHODS 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 χ 2 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. RESULTS Of the 119 patients, 80 (67%) developed SVR over the