Successful HCV therapy in diabetics reduces risk of T2D complications
Achieving sustained virological response (SVR) in hepatitis C virus (HCV)-infected patients with type 2 diabetes (T2D) substantially cuts the risk of developing acute coronary syndrome, end‐stage renal disease (ESRD), ischaemic stroke and retinopathy, regardless of cirrhosis, a study has shown.
The study included 1,242 patients (average age 59.4 years) from the Chronic Hepatitis Cohort Study (CHeCS) who were receiving glucose-lowering medications, among whom 721 (58 percent) were treated concomitantly with either interferon-based or direct-acting antivirals (DAAs). SVR occurred in 540 treated patients (75 percent).
During a median follow-up of 2.7 years, 143 patients developed acute coronary syndrome, 159 developed ESRD and 97 had ischaemic stroke. Retinopathy occurred in 187 patients during a median follow-up of 2.4 years. [Aliment Pharmacol Ther 2019;49:599-608]
In a propensity-score analysis addressing treatment selection bias, SVR was associated with significantly reduced risks of acute coronary syndrome (subdistribution hazard ratios [sHR], 0.36; p<0.001), ESRD (sHR, 0.46; p<0.001), stroke (sHR, 0.34; p<0.001) and retinopathy (sHR, 0.24; p<0.001) compared with no treatment.
Results were consistent in subgroups defined by antiviral treatment and cirrhosis status, as well as robust to sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy and treatment status as a time-varying covariate.
“Chronic HCV infection, independent of diabetic status, is known to confer an increased risk of extrahepatic complications; treatment status and outcome have been associated with improvement in some, but not all, of these conditions,” the authors noted.
“The present analysis from a large and diverse cohort of patients with T2D shows that successful HCV treatment reduced the risks of acute coronary syndrome, ESRD, ischaemic stroke and retinopathy by 39–66 percent,” they added.
Such a magnitude of risk reduction highlights the importance of antiviral therapy to reduce the risk of the said extrahepatic outcomes, they said.
There are several limitations to the study, including those inherent in the use of observational data drawn from real world patients. Also, there were no information regarding lifestyle modifications, such as increased physical activity or dietary changes, that might impact glucose control over time.
Moreover, the authors acknowledged that they were not able to examine whether antidiabetic medication type or dose changed during follow‐up.
“The results of all sensitivity analyses were [nevertheless] consistent with the main analysis and support our conclusions,” they said.