Diabetes mellitus is associated with impaired response to antiviral therapy in chronic hepatitis C infection

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Dig Dis Sci. 2009 Dec;54(12):2699-705.

Diabetes mellitus is associated with impaired response to antiviral therapy in

chronic hepatitis C infection.

Elgouhari HM, Zein CO, Hanouneh I, Feldstein AE, Zein NN.

Source

Avera Center for Liver Disease, Transplant Institute, Sanford School of

Medicine, University of South Dakota, 1001 East 21st Street, Suite 303, Sioux

Falls, South Dakota 57105, USA. hesham.elgouhari@...

Abstract

Insulin resistance may promote hepatic fibrosis in chronic hepatitis C (HCV) and

has emerged as a cofactor in failure to achieve sustained viral response (SVR).

AIMS: (1) To assess the association of diabetes mellitus (DM) in HCV patients to

the severity of hepatic fibrosis and to the response to antiviral treatment. (2)

To assess the safety of pegylated interferon and ribavirin combination therapy

(Peg IFN/RBV) in diabetic HCV patients. Methods HCV diabetics (n=61) were

identified. A 2:1 matching control group was used to identify independent

factors of advanced fibrosis and treatment failure. RESULTS: Compared to HCV

non-diabetics, HCV diabetics were more likely to have steatosis (P<0.0001) and

advanced fibrosis (P=0.003). Patients' age, Caucasian ethnicity, obesity, and

histologic activity index were independently associated with advanced fibrosis

(P<0.05). Only 23% of HCV diabetics achieved SVR compared to 46% of HCV

non-diabetics (P=0.003). DM, genotype 1, high baseline viral load, and African-

American ethnicity were independently associated with less SVR (P<0.05).

Significant adverse events were more common in HCV diabetics compared to HCV

non-diabetics (P=0.001). Side effects did not increase in patients receiving PEG

IFN/RBV and insulin sensitizers. Conclusion DM was associated with impaired

virologic response to PEG IFN/RBV in HCV patients. Adverse events during therapy

were more frequent in diabetic compared to non-diabetic HCV patients.

© Springer Science+Business Media, LLC 2009

PMID: 19148751 [PubMed - indexed for MEDLINE]