Abstract
BackgroundThe association between hepatitis C virus (HCV), insulin resistance (IR), and metabolic syndrome has been extensively investigated. Direct-acting antivirals (DAAs) have a high sustained virologic response (SVR) rate, reaching > 90%. The effect of SVR after DAA treatment on metabolic parameters and IR in nondiabetic patients could be an important factor in the patient’s long-term outcome. The aim of the study is to evaluate the impact of different DAA regimens on IR and sensitivity in naïve chronic HCV-infected nondiabetic patients (before and after 12 weeks of treatment).MethodsThis prospective cohort study was conducted on 100 HCV-infected Child A nondiabetic patients eligible for DAA treatment in the Department of Gastroenterology and Hepatology, Ain Shams University, and Kobry El-Kobba Military Hospital among patients attending the outpatient clinic.Patients were categorized into four groups according to the HCV regimens they received for 12 weeks.All patient were subjected to the following tests before and 12 weeks after treatment: HCV quantitative PCR, Fibroscan, fasting insulin level (using insulin quantitative test kit), fasting and postprandial blood glucose (PPG), lipid profile, liver enzymes, BMI, and waist circumference.ResultsAll patients achieved SVR at 12 weeks. In all treatment groups, lab was assessed before and after treatment, the 2-h PPG, high-density lipoprotein, and low-density lipoprotein levels showed statistically significant increases, whereas triglyceride, fasting glucose, hemoglobin A1C, and fasting plasma insulin levels showed statistically significant decreases. The homeostasis model assessment of insulin resistance (HOMA-IR) exhibited statistically significant decreases, whereas the quantitative insulin sensitivity check index (QUICKI) and Matsuda index showed statistically significant increases, across the four groups.ConclusionsDAA treatment in naïve nondiabetic HCV-infected patients affects metabolic profile and insulin resistance/sensitivity, with similar effect among different DAA regimens.
Highlights
The association between hepatitis C virus (HCV), insulin resistance (IR), and metabolic syndrome has been extensively investigated
Nonalcoholic steatohepatitis (NASH) was a common finding in liver biopsies collected before the initiation of HCV interferon treatment, and they were incorporated into the scoring system that predicted the antiviral response [7]
The patients were scored as Child A according to the Child–Pugh score diagnosed based on HCV-Ab by enzyme-linked immunosorbent assay (ELISA) and HCV ribonucleic acid (HCV RNA) by polymerase chain reaction (PCR) and received treatment with Direct-acting antivirals (DAAs)
Summary
The association between hepatitis C virus (HCV), insulin resistance (IR), and metabolic syndrome has been extensively investigated. The effect of SVR after DAA treatment on metabolic parameters and IR in nondiabetic patients could be an important factor in the patient’s long-term outcome. Hepatitis C virus (HCV) has a known diabetogenic- and insulin-resistance effect on the infected patients, which could be explained by the activation of various inflammatory pathways [1]. HCV genotype 4 is the most dominant in Egypt, differing from other genotypes in its effect on liver steatosis and response to DAAs [3, 4]. Insulin resistance, and hyperlipidemia is associated with HCV, even in the absence of obesity or diabetes [5, 6]. Nonalcoholic steatohepatitis (NASH) was a common finding in liver biopsies collected before the initiation of HCV interferon treatment, and they were incorporated into the scoring system that predicted the antiviral response [7]
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