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Hepatitis C virus eradication with direct‐acting antiviral improves insulin resistance
Sustained virological response (SVR) after interferon‐based therapy is associated with improvement of insulin resistance (IR) in HCV‐infected patients. Few data are available in the direct‐acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long‐term effect...
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| Published in: | Journal of viral hepatitis 2020-02, Vol.27 (2), p.188-194 |
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| container_end_page | 194 |
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| container_title | Journal of viral hepatitis |
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| creator | Russo, Francesco Paolo Zanetto, Alberto Gambato, Martina Bortoluzzi, Ilaria Al Zoairy, Ramona Franceschet, Enrica De Marchi, Federica Marzi, Luca Lynch, Erica Nicola Floreani, Annarosa Farinati, Fabio Schaefer, Benedikt Burra, Patrizia Zoller, Heinz Mega, Andrea |
| description | Sustained virological response (SVR) after interferon‐based therapy is associated with improvement of insulin resistance (IR) in HCV‐infected patients. Few data are available in the direct‐acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long‐term effect of DAAs on IR. Patients treated with DAAs between May 2015 and December 2016 in 3 tertiary care centres were recruited. Patients with diabetes were excluded. Biochemical and virological data were collected at baseline, 12/24/48 weeks (W) after the end of therapy (EOT). Presence of IR was defined by a ‘homeostasis model assessment index for IR’ [HOMA‐IR])> 2.5. Liver fibroscan was performed at baseline, at 24/48W after EOT. Hundred and thirty‐eight patients were enrolled (mean age 58 years, M/F 85/53, GT1 61%, 68.8% cirrhotic). Sixty‐eight patients (94/138) had IR. Patients with IR had significantly higher stiffness than patients without it (23 ± 12 vs 15 ± 8; P |
| doi_str_mv | 10.1111/jvh.13215 |
| format | article |
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Few data are available in the direct‐acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long‐term effect of DAAs on IR. Patients treated with DAAs between May 2015 and December 2016 in 3 tertiary care centres were recruited. Patients with diabetes were excluded. Biochemical and virological data were collected at baseline, 12/24/48 weeks (W) after the end of therapy (EOT). Presence of IR was defined by a ‘homeostasis model assessment index for IR’ [HOMA‐IR])> 2.5. Liver fibroscan was performed at baseline, at 24/48W after EOT. Hundred and thirty‐eight patients were enrolled (mean age 58 years, M/F 85/53, GT1 61%, 68.8% cirrhotic). Sixty‐eight patients (94/138) had IR. Patients with IR had significantly higher stiffness than patients without it (23 ± 12 vs 15 ± 8; P < .0001). SVR12 was achieved in 135 (98%) patients, and 124 (90%) patients reached the 48W post‐EOT. At this time point, the percentage of patients with IR significantly decreased to 49% (P = 0,01). HOMA‐IR was significantly lower than baseline (1.8 vs 3; P < .001), and this was related to a significant reduction of insulin level (11.7 ± 6.3 vs 16.4 ± 8.3). High BMI was associated with a significantly lower probability of achieving a non‐IR status at 24W (P = .05) and 48W (P = .03).In conclusion, SVR following DAAs led to a significant reduction of IR, even in patients with cirrhosis. Nevertheless, IR can persist after the achievement of SVR, especially in patients with high BMI.</description><identifier>ISSN: 1352-0504</identifier><identifier>EISSN: 1365-2893</identifier><identifier>DOI: 10.1111/jvh.13215</identifier><identifier>PMID: 31596996</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Aged ; Antiviral agents ; Antiviral Agents - therapeutic use ; Cirrhosis ; Cohort Studies ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - prevention & control ; direct‐acting antivirals ; Disease resistance ; Elasticity Imaging Techniques ; Female ; Hepacivirus - drug effects ; Hepatitis C ; hepatitis C virus ; Hepatitis C, Chronic - drug therapy ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Interferon ; Interferons - therapeutic use ; Liver - diagnostic imaging ; Liver - virology ; Liver cirrhosis ; Male ; Middle Aged ; Prospective Studies ; Sustained Virologic Response ; Treatment Outcome</subject><ispartof>Journal of viral hepatitis, 2020-02, Vol.27 (2), p.188-194</ispartof><rights>2019 John Wiley & Sons Ltd</rights><rights>2019 John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-79e384914e1f9ec31c5e35e21d64beec4d8e129d4228a1e754431c587119e2b73</citedby><cites>FETCH-LOGICAL-c3535-79e384914e1f9ec31c5e35e21d64beec4d8e129d4228a1e754431c587119e2b73</cites><orcidid>0000-0003-4127-8941 ; 0000-0002-2944-1374 ; 0000-0002-0101-1938 ; 0000-0002-6734-7178 ; 0000-0003-2630-7054 ; 0000-0002-8791-191X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31596996$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Russo, Francesco Paolo</creatorcontrib><creatorcontrib>Zanetto, Alberto</creatorcontrib><creatorcontrib>Gambato, Martina</creatorcontrib><creatorcontrib>Bortoluzzi, Ilaria</creatorcontrib><creatorcontrib>Al Zoairy, Ramona</creatorcontrib><creatorcontrib>Franceschet, Enrica</creatorcontrib><creatorcontrib>De Marchi, Federica</creatorcontrib><creatorcontrib>Marzi, Luca</creatorcontrib><creatorcontrib>Lynch, Erica Nicola</creatorcontrib><creatorcontrib>Floreani, Annarosa</creatorcontrib><creatorcontrib>Farinati, Fabio</creatorcontrib><creatorcontrib>Schaefer, Benedikt</creatorcontrib><creatorcontrib>Burra, Patrizia</creatorcontrib><creatorcontrib>Zoller, Heinz</creatorcontrib><creatorcontrib>Mega, Andrea</creatorcontrib><title>Hepatitis C virus eradication with direct‐acting antiviral improves insulin resistance</title><title>Journal of viral hepatitis</title><addtitle>J Viral Hepat</addtitle><description>Sustained virological response (SVR) after interferon‐based therapy is associated with improvement of insulin resistance (IR) in HCV‐infected patients. Few data are available in the direct‐acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long‐term effect of DAAs on IR. Patients treated with DAAs between May 2015 and December 2016 in 3 tertiary care centres were recruited. Patients with diabetes were excluded. Biochemical and virological data were collected at baseline, 12/24/48 weeks (W) after the end of therapy (EOT). Presence of IR was defined by a ‘homeostasis model assessment index for IR’ [HOMA‐IR])> 2.5. Liver fibroscan was performed at baseline, at 24/48W after EOT. Hundred and thirty‐eight patients were enrolled (mean age 58 years, M/F 85/53, GT1 61%, 68.8% cirrhotic). Sixty‐eight patients (94/138) had IR. Patients with IR had significantly higher stiffness than patients without it (23 ± 12 vs 15 ± 8; P < .0001). SVR12 was achieved in 135 (98%) patients, and 124 (90%) patients reached the 48W post‐EOT. At this time point, the percentage of patients with IR significantly decreased to 49% (P = 0,01). HOMA‐IR was significantly lower than baseline (1.8 vs 3; P < .001), and this was related to a significant reduction of insulin level (11.7 ± 6.3 vs 16.4 ± 8.3). High BMI was associated with a significantly lower probability of achieving a non‐IR status at 24W (P = .05) and 48W (P = .03).In conclusion, SVR following DAAs led to a significant reduction of IR, even in patients with cirrhosis. Nevertheless, IR can persist after the achievement of SVR, especially in patients with high BMI.</description><subject>Aged</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Cirrhosis</subject><subject>Cohort Studies</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - prevention & control</subject><subject>direct‐acting antivirals</subject><subject>Disease resistance</subject><subject>Elasticity Imaging Techniques</subject><subject>Female</subject><subject>Hepacivirus - drug effects</subject><subject>Hepatitis C</subject><subject>hepatitis C virus</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Homeostasis</subject><subject>Humans</subject><subject>Insulin</subject><subject>Insulin Resistance</subject><subject>Interferon</subject><subject>Interferons - therapeutic use</subject><subject>Liver - diagnostic imaging</subject><subject>Liver - virology</subject><subject>Liver cirrhosis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Sustained Virologic Response</subject><subject>Treatment Outcome</subject><issn>1352-0504</issn><issn>1365-2893</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kM9OAjEQhxujEUQPvoBp4snDwvbf7vZoiIqGxIsab03pDlKyLNh2Idx8BJ_RJ7G46M25zGTy5TeTD6FzkvZJrMF8PesTRok4QF3CMpHQQrLD3SxokoqUd9CJ9_M0jZAgx6jDiJCZlFkXvY5gpYMN1uMhXlvXeAxOl9bE5bLGGxtmuLQOTPj6-NQm2PoN6zrYiOoK28XKLdfgsa19U9kaO_DWB10bOEVHU115ONv3Hnq-vXkajpLx49398HqcGCaYSHIJrOCScCBTCYYRI4AJoKTM-ATA8LIAQmXJKS00gVxwvmOKnBAJdJKzHrpsc-Mn7w34oObLxtXxpKKMZTKLQnikrlrKuKX3DqZq5exCu60iqdo5VNGh-nEY2Yt9YjNZQPlH_kqLwKAFNraC7f9J6uFl1EZ-AymgfFI</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Russo, Francesco Paolo</creator><creator>Zanetto, Alberto</creator><creator>Gambato, Martina</creator><creator>Bortoluzzi, Ilaria</creator><creator>Al Zoairy, Ramona</creator><creator>Franceschet, Enrica</creator><creator>De Marchi, Federica</creator><creator>Marzi, Luca</creator><creator>Lynch, Erica Nicola</creator><creator>Floreani, Annarosa</creator><creator>Farinati, Fabio</creator><creator>Schaefer, Benedikt</creator><creator>Burra, Patrizia</creator><creator>Zoller, Heinz</creator><creator>Mega, Andrea</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><orcidid>https://orcid.org/0000-0003-4127-8941</orcidid><orcidid>https://orcid.org/0000-0002-2944-1374</orcidid><orcidid>https://orcid.org/0000-0002-0101-1938</orcidid><orcidid>https://orcid.org/0000-0002-6734-7178</orcidid><orcidid>https://orcid.org/0000-0003-2630-7054</orcidid><orcidid>https://orcid.org/0000-0002-8791-191X</orcidid></search><sort><creationdate>202002</creationdate><title>Hepatitis C virus eradication with direct‐acting antiviral improves insulin resistance</title><author>Russo, Francesco Paolo ; 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Few data are available in the direct‐acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long‐term effect of DAAs on IR. Patients treated with DAAs between May 2015 and December 2016 in 3 tertiary care centres were recruited. Patients with diabetes were excluded. Biochemical and virological data were collected at baseline, 12/24/48 weeks (W) after the end of therapy (EOT). Presence of IR was defined by a ‘homeostasis model assessment index for IR’ [HOMA‐IR])> 2.5. Liver fibroscan was performed at baseline, at 24/48W after EOT. Hundred and thirty‐eight patients were enrolled (mean age 58 years, M/F 85/53, GT1 61%, 68.8% cirrhotic). Sixty‐eight patients (94/138) had IR. Patients with IR had significantly higher stiffness than patients without it (23 ± 12 vs 15 ± 8; P < .0001). SVR12 was achieved in 135 (98%) patients, and 124 (90%) patients reached the 48W post‐EOT. At this time point, the percentage of patients with IR significantly decreased to 49% (P = 0,01). HOMA‐IR was significantly lower than baseline (1.8 vs 3; P < .001), and this was related to a significant reduction of insulin level (11.7 ± 6.3 vs 16.4 ± 8.3). High BMI was associated with a significantly lower probability of achieving a non‐IR status at 24W (P = .05) and 48W (P = .03).In conclusion, SVR following DAAs led to a significant reduction of IR, even in patients with cirrhosis. Nevertheless, IR can persist after the achievement of SVR, especially in patients with high BMI.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31596996</pmid><doi>10.1111/jvh.13215</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-4127-8941</orcidid><orcidid>https://orcid.org/0000-0002-2944-1374</orcidid><orcidid>https://orcid.org/0000-0002-0101-1938</orcidid><orcidid>https://orcid.org/0000-0002-6734-7178</orcidid><orcidid>https://orcid.org/0000-0003-2630-7054</orcidid><orcidid>https://orcid.org/0000-0002-8791-191X</orcidid></addata></record> |
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| subjects | Aged Antiviral agents Antiviral Agents - therapeutic use Cirrhosis Cohort Studies Diabetes Diabetes mellitus Diabetes Mellitus - prevention & control direct‐acting antivirals Disease resistance Elasticity Imaging Techniques Female Hepacivirus - drug effects Hepatitis C hepatitis C virus Hepatitis C, Chronic - drug therapy Homeostasis Humans Insulin Insulin Resistance Interferon Interferons - therapeutic use Liver - diagnostic imaging Liver - virology Liver cirrhosis Male Middle Aged Prospective Studies Sustained Virologic Response Treatment Outcome |
| title | Hepatitis C virus eradication with direct‐acting antiviral improves insulin resistance |
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