Interferon-based antiviral therapy for hepatitis C and diabetes

The article is written by Master, Doctor Mai Vien Phuong - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Observations suggest that metabolic changes, such as insulin resistance and diabetes mellitus (DM), are reduced to some extent after clearance of the hepatitis C virus. In particular, therapy Interferon-based antivirals have been shown to reduce the incidence of diabetes.

The association between chronic hepatitis C infection and extrahepatic manifestations (EHM), especially cardiometabolic disease, has been studied extensively. However, there is no adequate assessment of these extrahepatic manifestations following viral cure. Several multi-pronged mechanisms have been proposed to explain the potential for the development of extrahepatic manifestations of hepatitis C virus (HCV), cardiometabolic mechanisms, as well as the effect of antiviral therapy to address these conditions. this extrahepatic manifestation. Data on these manifestations after sustained virological response (SVR) is still conflicting. However, current evidence suggests that hepatic steatosis and its coexistence of hypocholesterolemia after successful eradication of the virus lead to unfavorable lipid metabolism, increasing the risk of heart disease. circuit (CVD).

Chronic hepatitis C infection is associated with significant morbidity and mortality globally, affecting approximately 2.5% of individuals (or 177.5 million people) worldwide. It is currently one of the leading causes of hepatocellular carcinoma (HCC) and decompensated cirrhosis requiring liver transplantation in Western countries. The primary goal of treatment is to achieve cure of the infection or a sustained virological response (sustained virological response), defined as undetectable HCV RNA in serum 12 or 24 weeks after termination. treatment. Since the introduction of the first-generation direct-acting antivirals (DAAs), boceprevir and telaprevir, in 2011 there has been a rapidly increasing number of patients with hepatitis C achieving SVR. .

Eradicating the virus is associated with a marked reduction in the risk of end-stage liver disease, the need for a liver transplant, and death. Although HCV is a hepatotropic virus, over the past two decades several studies have described an association between HCV and a heterogeneous array of extrahepatic manifestations (extrahepatic manifestations).
However, the mechanism by which viruses cause systemic diseases remains to be elucidated. The endocrine-metabolic changes, most commonly seen in patients with hepatitis C infection, are thought to be due to direct and indirect effects on dysregulation of host lipid and glucose metabolism as well as alterations in blood glucose levels. fat cells released from adipose tissue.
Similarly, hepatitis C infection has also been identified as an independent predictor of cardiovascular events, such as carotid atherosclerosis, stroke, myocardial ischemia, and heart failure. are all associated with poor outcomes. However, the impact on cardiovascular disease (cardiovascular disease risk) has not been fully established. Clinically, the prognosis of hepatitis C infection depends not only on liver-related outcomes but also on extrahepatic sequelae.

Most observations suggest that metabolic changes, such as insulin resistance and diabetes mellitus (DM), are reduced to some extent after viral clearance. These changes appear to be HCV genotype dependent. Interferon-based antiviral therapy and direct-acting antivirals have been shown to reduce the incidence of diabetes. Large epidemiological studies examining the effects of SVR on cardiovascular disease have shown great variability in outcomes. The findings primarily indicate that CVD risk events are reduced in SVR patients compared with nonresponders or untreated patients.

Interferon-based antiviral therapy and direct-acting antivirals have been shown to reduce the incidence of diabetes. Large epidemiological studies examining the effects of SVR on cardiovascular disease have shown great variability in outcomes, with findings primarily indicating heart disease risk events. pulse reduction in patients with SVR compared with nonresponders or untreated. In this review, the authors present a summary of current knowledge regarding extrahepatic sequelae of hepatitis C infection following sustained virological response, which may have implications for practice. health care provider clinical setting. Large epidemiological studies examining the effects of SVR on cardiovascular disease have shown great variability in outcomes, with findings primarily indicating heart disease risk events. pulse reduction in patients with SVR compared with nonresponders or untreated.
In summary, a lot of evidence shows that hepatitis C infection has a high rate of cardiovascular disease and metabolic changes such as dyslipidemia, fatty liver, insulin resistance (insulin resistance), obesity and diabetes.

References: Shengir M, Elgara M, Sebastiani G. Metabolic and cardiovascular complications after hepatitis C virus cure: What lies behind. World J Gastroenterol 2021; 27 (17): 1959-1972 [DOI: 10.3748 / wjg.v27.i17.1959]