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Direct-acting antiviral therapy protects against diabetes for adults with HCV

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Adults with hepatitis C who are treated with direct-acting antiviral therapy are less likely to develop diabetes than those who are treated with pegylated interferon/ribavirin or untreated, according to findings presented at the Conference on Retroviruses and Opportunistic Infections 2019 in Seattle.

Adeel Ajwad Butt

“This is important to note because it gives us an idea of what is it that really drives the incidence of hepatitis with diabetes in people treated with these regimens,” Adeel Ajwad Butt, MD, MS, FACP, FIDSA, professor of medicine and professor of health care policy and research at Weill Cornell Medical College, said during a press conference.

Butt and colleagues compared direct-acting antiviral (DAA) therapy with pegylated interferon/ribavirin (PEG/RBV) treatment and no treatment in HCV and assessed the effect on diabetes incidence after at least 12 weeks. Data were pulled from the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) database. A total of 21,279 adults treated with DAA therapy and 4,764 adults treated with PEG/RBV were identified and matched to the same number of untreated participants.

Researchers found a lower incidence rate of diabetes in participants who were treated for HCV (15.4 per 1,000 person-years; 95% CI, 14.4-16.4) than for those who were not treated (20.6 per 1,000 person-years; 95% CI, 19.6-21.6). DAA treatment was associated with the lowest incidence rate of diabetes (9.89 per 1,000 person-years; 95% CI, 8.7-11.1) compared with PEG/RBV treatment (19.8 per 1,000 person-years; 95% CI, 18.3-21.4) and no treatment (20.6 per 1,000 person-years; 95% CI, 19.6-21.6).

Among all participants who were treated with DAA or PEG/RBV, those who achieved sustained virologic response had a lower incidence rate (13.3 per 1,000 person-years; 95% CI, 12.2-14.5) than those who did not (19.2 per 1,000 person-years; 95% CI, 17.4-21.1).

The researchers further noted that treatment of any kind was particularly beneficial for participants with advanced liver fibrosis or cirrhosis, with a fibrosis-4 index score of greater than 3.25, leading to an incidence rate of 25.3 per 1,000 person-years (95% CI, 22.1-28.6) in untreated participants and a rate of 15.5 per 1,000 person-years (95% CI, 13.1-17.9) in treated participants.

“There are other benefits to treatment with DAA regimens than viral eradication,” Butt said. “We might be able to reduce the extreme complications of HCV infection by treating people with DAA regimens.” – by Phil Neuffer

Reference:

Butt A, et al. Incident diabetes and glucose control after HCV treatment with DAAs in ERCHIVES. Presented at: Conference on Retroviruses and Opportunistic Infections (CROI) 2019; March 4-7, 2019; Seattle.

For more information:

Adeel Ajwad Butt, MD, MS, FACP, FIDSA, can be reached at aab2005@qatar-med.cornell.edu.

Disclosure: Butt reports he has received grant support (to the institution, Veterans Research Foundation of Pittsburgh) from Gilead Sciences and Merck.