Can the degree of hepatic fibrosis and hepatitis C virus characteristics influence glucose and lipid metabolism in sustained virological response with direct acting antivirals?
DOI:
https://doi.org/10.5902/2236583485101Palabras clave:
Direct-acting antivirals, Insulin resistance, Hepatitis C, Hepatic fibrosis, Glucose and lipid metabolismResumen
Objective: To assess the metabolic impact the sustained virological response (SVR) using direct acting antivirals according to liver fibrosis degree and virus characteristics in patients with chronic hepatitis C (HCV). Methods: Prospective pre-post intervention study. Patients were categorized according to genotypes (G) and fibrosis (F) categories. Glucose metabolism was evaluated using: HOMA-IR, HOMA-β, TyG, and HbA1c and lipid metabolism: total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins and triglycerides. Statistical analysis involved paired t-test to compare the means of the variables between the pretreatment and SVR periods. A p-value of <0.05 was considered as significant. Results: Among 273 patients, average age of 57 years; 45.8% prediabetic; 18.3% diabetic; 28.6% cirrhotic, and 33.7% had mild or absent fibrosis (F0/F1); with respect to genotypes, 53.9% G1: subtypes G1a (46.60%) and G1b (53.40%). The lipid profile showed a significant increase in triglycerides, TC, and LDL in the SVR. The HOMA-IR index showed no significant differences, while the HOMA-β index significantly increased in patients with advanced fibrosis (F3/F4) (p=0.044). The TyG index significantly increased in patients F0/F1 fibrosis (p=0.002), patients without cirrhosis (p=0.005), patients G1 without cirrhosis (p=0.024), and patients G1a without cirrhosis (p=0.021). HbA1c decreased in patients F3/F4 fibrosis (p=0.038), patients without cirrhosis (p=0.010), patients G1a without cirrhosis (p=0.015), and patients non-1 genotype without cirrhosis (p=0.010). Final Considerations: The SVR showed variable metabolic influences, indicating potential lipid profile impairment and glycemic profile improvement. Differences were observed depending on the degree of fibrosis and genotypes, underscoring the importance of recognizing the peculiarities of the constituted samples.
Descargas
Citas
Chen Y, Ji H, Shao J, Jia Y, Bao Q, Zhu J, et al. Different Hepatitis C Virus Infection Statuses Show a Significant Risk of Developing Type 2 Diabetes Mellitus: A Network Meta-Analysis. Dig Dis Sci. 2020 Jul;65(7):1940–50.
Wong RJ, Gish RG. Metabolic manifestations and complications associated with chronic hepatitis C virus infection. Gastroenterol Hepatol. 2016;12(5):293–9.
Cacoub P, Comarmond C, Domont F, Savey L, Desbois AC, Saadoun D. Extrahepatic manifestations of chronic hepatitis C virus infection. Ther Adv Infect Dis. 2016 Feb;3(1):3–14.
Bose SK, Ray R. Hepatitis C virus infection and insulin resistance. World J Diabetes. 2014 Feb;5(1):52–8.
Meissner EG, Lee Y-J, Osinusi A, Sims Z, Qin J, Sturdevant D, et al. Effect of sofosbuvir and ribavirin treatment on peripheral and hepatic lipid metabolism in chronic hepatitis C virus, genotype 1-infected patients. Hepatology. 2015 Mar;61(3):790–801.
Hum J, Jou JH, Green PK, Berry K, Lundblad J, Hettinger BD, et al. Improvement in glycemic control of type 2 diabetes after successful treatment of hepatitis c virus. Diabetes Care. 2017;40(9):1173–80.
Ciancio A, Bosio R, Bo S, Pellegrini M, Sacco M, Vogliotti E, et al. Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct-acting antiviral agents. J Med Virol [Internet]. 2018;90(2):320–7. Available from: https://dx.doi.org/10.1002/jmv.24954
Morales AL, Junga Z, Singla MB, Sjogren M, Torres D. Hepatitis C eradication with sofosbuvir leads to significant metabolic changes. World J Hepatol. 2016;8(35):1557–63.
Jain A, Kalra BS, Srivastava S, Chawla S. Effect of sofosbuvir and daclatasvir on lipid profile, glycemic control and quality of life index in chronic hepatitis C, genotype 3 patients. Indian J Gastroenterol. 2019;38(1):39–43.
Cheng PN, Chen JY, Chiu YC, Chiu HC, Tsai LM. Augmenting central arterial stiffness following eradication of HCV by direct acting antivirals in advanced fibrosis patients. Sci. Rep. 2019; 9:1426. Available from: https://doi.org/10.1038/s41598-018-37829-4
Chen JY, Cheng PN, Chiu HC, Tsai WC, Tsai LM. Persistent augmentation of central arterial stiffness following viral clearance by direct-acting antivirals in chronic hepatitis C. Journal of Viral hepatitis. 2021;28(1):159-67. Available from: https://doi.org/10.1111/jvh.13406
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.
Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347–51.
SOCIEDADE BRASILEIRA DE DIABETES. Diretrizes da sociedade Brasileira de Diabetes 2019-2020. Vol. 8, Alamedas. 2019. p. 178–80.
Chang M-L. Metabolic alterations and hepatitis C: From bench to bedside. World J Gastroenterol. 2016 Jan;22(4):1461–76.
Brasil. Ministério da Saúde. Protocolo Clínico e Diretrizes Terapêuticas para Hepatite C e Coinfecções. Secr Vigilância em Saúde Dep DST, Aids e Hepatites Virais. 2019;148:148–62.
Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, et al. Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes. Aliment Pharmacol Ther [Internet]. 2019;49(5):599–608. Available from: https://dx.doi.org/10.1111/apt.15102
Lanini S, Bartolini B, Taibi C, Agresta A, Garbuglia AR, Montaldo C, et al. Early improvement of glycaemic control after virus clearance in patients with chronic hepatitis C and severe liver fibrosis: a cohort study. New Microbiol [Internet]. 2019;42(3):139–44. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-31305933
Adinolfi LE, Nevola R, Guerrera B, D’Alterio G, Marrone A, Giordano M, et al. Hepatitis C virus clearance by direct‐acting antiviral treatments and impact on insulin resistance in chronic hepatitis C patients. J Gastroenterol Hepatol. 2018;33(7):1379–82.
Shehab Eldin W, Nada A, Abdulla A, Eldeen SS. The Effect of Hepatitis C Virus Eradication with New Direct Acting Antivirals on Glucose Homeostasis in Non-Diabetic Egyptian Patients. J Diabetes Metab. 2017;8(10):8–11.
Moehlecke Iser BP, Pinheiro PC, Malta DC, Duncan BB, Schmidt MI. Prediabetes and intermediate hyperglycemia prevalence in adults and associated factors, health national survey. Cienc e Saude Coletiva. 2021;26(2):531–40.
Brasil. Ministério da Economia. Instituto Brasileiro de Geografia e Estatistica (IBGE). Pesquisa nacional de saúde 2019: informações sobre domicílios, acesso e utilização dos serviços de saúde: Brasil, Grandes Regiões e Unidades da Federação. Instituto Brasileiro de Geografia e Estatistica- IBGE. 2020. 31–33 p.
Serfaty L. Metabolic Manifestations of Hepatitis C Virus: Diabetes Mellitus, Dyslipidemia. Clin Liver Dis [Internet]. 2017;21(3):475–86. Available from: http://dx.doi.org/10.1016/j.cld.2017.03.004
Doyle M-A, Galanakis C, Mulvihill E, Crawley A, Cooper CL. Hepatitis C Direct Acting Antivirals and Ribavirin Modify Lipid but not Glucose Parameters. Cells. 2019 Mar;8(3).
Carvalho JR, Velosa J, Serejo F. Lipids, glucose and iron metabolic alterations in chronic hepatitis C after viral eradication— comparison of the new direct-acting antiviral agents with the old regimens. Scand. J. Gastroenterol. 2018; 53:857–863. Available from: https://doi.org/ 10.1080/00365521.2018.1473486
Russo FP, Zanetto A, Gambato M, Bortoluzzi I, Al Zoairy R, Franceschet E, et al. Hepatitis C virus eradication with direct-acting antiviral improves insulin resistance. J Viral Hepat [Internet]. 2020;27(2):188–94. Available from: https://dx.doi.org/10.1111/jvh.13215
Boraie MB, Elnaggar YA, Ahmed MO, Mahmoud AM. Effect of direct acting antiviral therapy of Chronic Hepatitis C virus on insulin resistance and Type2 DM in Egyptian patients (prospective study). Diabetes Metab Syndr [Internet]. 2019;13(4):2641–6. Available from: https://dx.doi.org/10.1016/j.dsx.2019.07.032
Gitto S, Cicero AFG, Loggi E, Giovannini M, Conti F, Grandini E, et al. Worsening of Serum Lipid Profile after Direct Acting Antiviral Treatment. Ann. Hepatol. 2018;17:64-75. Available from: https://doi.org/10.5604/01.3001.0010.7536
Weidner P, Boettche D, Zimmerer T, Burgermeister E, Teufel A, Ebert MPA, et al. Impact of direct acting antiviral (DAA) treatment on glucose metabolism and reduction of pre-diabetes in patients with chronic hepatitis C. J Gastrointest Liver Dis. 2018;27(3):281–9.
Stine JG, Wynter JA, Niccum B, Kelly V, Caldwell SH, Shah NL. Effect of Treatment with Direct Acting Antiviral on Glycemic Control in Patients with Diabetes Mellitus and Chronic Hepatitis C. Ann Hepatol [Internet]. 2017;16(2):215–20. Available from: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-26812017000200215&lang=pt
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2025 Jucéli Márcia Hendges Sparvoli, Antonio Cardoso Sparvoli, Afonso Alexandre Pereira, Ana Luisa Machado de Paula, Carla Vitola Gonçalves
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Direito autoral (Copyright): todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons Atribuição-NãoComercial-SemDerivações 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BR/.
A Declaração de Direito Autoral e os itens a serem observados podem ser visualizados abaixo:
1. Política para Periódicos de Acesso Livre
Autores que publicam nesta revista concordam com os seguintes termos:
a) Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
b) Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
c) Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
Todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons Atribuição-NãoComercial-SemDerivações 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BR/.
