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Impact of Direct Acting Antiviral (DAA) Treatment on Glucose Metabolism and Reduction of Pre-diabetes in Patients with Chronic Hepatitis C

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Philip Weidner1, Dominik Boettche1, Thomas Zimmerer2, Elke Burgermeister1, Andreas Teufel1, Matthias P.A. Ebert1, Christoph Antoni1

1) Dept. of Medicine II, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
2) Clinic of Internal Medicine, Center of Gastroenterology, East-Tallinn Central Hospital, 10138 Tallinn, Estland

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.273.daa

Background & Aim: With the development of direct acting antiviral agents (DAA) chronic hepatitis C virus (HCV) infection has become curable in most patients. Since HCV infection is known to have direct and/or indirect effects on glucose metabolism, successful HCV treatment may have an impact in reducing glucose level, pre-diabetes, the need of treatment for diabetes, and ultimately diabetes-associated morbidity. We investigated the association of DAA treatment and glucose metabolism in the context of development or resolution of hepatic fibrosis in a large cohort of HCV- infected patients.

Methods: In this retrospective single-center observational study, we investigated 281 patients receiving alloral DAA therapy for fasting plasma glucose, HbA1c, liver enzymes an  general clinical chemistry, measured during a 52-week follow-up. In addition, elastography, FIB-4- and APRI-calculation were used to assess hepatic fibrosis non-invasively.

Results: Successful elimination of HCV through DAA treatment was associated with a significant drop in fasting glucose level and a reduced rate of impaired fasting plasma glucose (FPG). Interestingly, this metabolic change was BMI-independent. In addition, long-term glucose levels also decreased after successful DAA treatment.
A significant APRI-score reduction was associated with a persistent improvement of FPG. However, DAA did not have an impact on glucose metabolism in patients suffering from liver cirrhosis.

Conclusion: This study highlights the beneficial impact of successful HCV therapy on glucose metabolism and identifies patients with liver cirrhosis as a collective in need of intensified surveillance with regard to diabetes progression despite HCV eradication.

Key words: Hepatitis C − direct acting antiviral − diabetes − metabolism.

Abbreviations: DAA: direct acting antiviral agents; FPG: fasting plasma glucose; HCV: hepatitis C virus; IFG: impaired fasting glucose; SVR: sustained virological response.