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SVR in HCV genotype 1 improves insulin resistance

Patients with hepatitis C genotype 1 who achieved sustained virologic response after direct-acting antiviral treatment had significant improvement or reversal of insulin resistance, according to a recently published study.

“Both experimental and clinical studies have demonstrated that HCV induces [insulin resistance (IR). Moreover, a close correlation between the viral load and IR was observed in genotype 1 infection, indicating a possible direct link between the two conditions,” Luigi E. Adinolfi, MD, from University of Campania, Italy, and colleagues wrote. “Our study demonstrated that HCV patients reaching SVR have a better glycemic control, thus it is possible to hypothesize that clearance of HCV in diabetic patients could improve the glucose homeostasis control.”

The researchers enrolled 68 patients with HCV genotype 1 and advanced fibrosis who underwent DAA therapy with simeprevir and sofosbuvir with ribavirin, ledipasvir and sofosbuvir with ribavirin, or ombitasvir/paritaprevir/ritonavir with dasabuvir and ribavirin. They also enrolled 65 control patients with HCV.

At baseline, 52.3% of treated and 53.8% of control patients showed IR. At the end of treatment, all patients cleared HCV RNA and 65 patients achieved SVR. No patient made significant changes to lifestyle, diet or physical activity during the study period.

Among the patients treated for HCV, HOMA-IR (4.9 vs. 2.38; P < .0001), HOMA-S (81.2% vs. 104%; P < .001), HOMA-B (136.9% vs. 119.2%; P < .007), fasting insulin (16.21 vs. 10.49 uU/mL; P < .001), fasting glucose (97.57 vs. 86.71 mg/dL; P < .001) and IR (52.3% vs. 29%; P < .001) improved from baseline to end of treatment.

Similarly, from end to treatment to 3 months post SVR, HOMA-IR (2.24; P < .0001), HOMA-S (108%; P < .0001), HOMA-B (117%; P < .006), fasting insulin (9.43 uU/mL; P < .0001), fasting glucose (85.33 mg/dL; P < .0001) and IR (29.5%; P < .0001) improved among the treated patients.

The researchers observed no significant changes in fasting insulin, fasting glucose or IR among the control group.

At baseline, HOMA-IR correlated significantly with HCV RNA levels (r = 0.293; P < .018). At 3 months follow-up, persistent IR correlated with the highest values of liver fibrosis (r = 0.26; P < .04).

“On the basis of these data, it is possible to hypothesize that HCV clearance by DAAs improving IR and reducing stress on beta-cell function prevents or delay the development of type 2 diabetes mellitus and/or metabolic syndrome in chronic HCV infected patients,” the researchers concluded. “Furthermore, IR in HCV patients is strictly correlated with metabolic syndrome, as well as reduced levels of adiponectinemia and it is a determinant for increased vessel wall stiffness and oxidative stress, thus clearance of HCV could improve IR-related cardiovascular events.” – by Talitha Bennett

Disclosure: Adinolfi reports he received financial report from AbbVie. Please see the full study for the other researchers’ relevant financial disclosures.