الفهرس 
HEPATITIS C INFECTIONOnly 14 pages are availabe for public view
 |  | from | 143 |  |  |
| | | from | 143 | | |
Abstract
SUMMARY
HCV and DM are chronic diseases with high global prevalence of epidemic proportions. the association between Hepatitis C and DM has been proved by many studies in the last two decades and represents an interrelated association. on the one hand, HCV infection triggers Diabetes, mostly type 2. The current management guidelines included DAAs in the HCV eradication (Fabiani et al., 2018).
Hepatitis C virus (HCV) is a major cause of chronic liver disease, including cirrhosis and liver cancer. The World Health Organization (WHO) has reported that 170 million people are chronically infected with HCV globally. The highest prevalence of HCV infection worldwide is in Egypt (15%), where 90% of HCV infection is genotype 4 (WHO, 2020).
It is now prevalent across the world with multiple complications. In 2014, around 422 million people were affected by DM and 1.5 million deaths were reported in 2012, in Egypt, 8.9 million patients are reported to have Diabetes Mellitus, and this is expected to rise significantly in the future (IDF, 2017).
The more effective oral pharmacologic therapy with less adverse effect is metformin. It does not result in gaining of weight besides its economical unless contraindicated. Efficacy can be improved with addition of second agents to it like co-transporter for example -2 (SGLT-2) and class of drugs inhibitors for example dipeptidyl peptidase-4 (DPP-4) (Belvins et al., 2020).
Up to one third of patients with chronic hepatitis C virus (HCV) develop type 2 diabetes mellitus (DM). This prevalence is much higher than that observed in the general population, and in patients with other chronic liver diseases such as hepatitis B virus, alcoholic liver disease, and primary biliary cirrhosis. Further, HCV seropositivity in patients with DM appears to be higher than in the general population. Post liver transplantation DM also appears to be higher among patients with HCV. In this section, we review the epidemiologic association between HCV and DM, highlighting the most recent pathophysiologic insights into the mechanisms underlying this association (WHO, 2016).
A positive association between HCV infection and DM has been reported in several clinical studies. In a recent publication, data from the NHANES III (third National Health and Nutrition Examination Survey) provided compelling evidence for the unique association between HCV infection and DM. In this large cross-sectional survey, HCV-positive persons who were 40 years of age or older had an adjusted odds ratio of 3.77 for the development of type 2 DM compared with HCV-negative persons (Fabiani et al., 2018).
Both HCV and T2D are prevalent with a high diseases burden all over the globe with no cure available for both until the innovation of DAA for treatment of HCV (Asselah et al., 2018).
There is a significant breakthrough recently in the treatment of chronic HCV infection caused by the discovery of direct-acting antivirals (DAA). Using a combination of at least two of DAA, specifically NS5A inhibitor, NS5B inhibitor, or NS3/4a protease inhibitor, results in a high response rate. Nowadays, DAAs are considered the gold standard of HCV treatment. DAAs are tolerable, effective and achieve a SVR in 90–98% of cases (Asselah et al., 2018).
All-oral, IFN–free DAAs combinations are currently effective to achieve a cure to HCV in more than 90% of HCV patients after a treatment of 12 weeks. In the future, it is expected that more IFN-free regimens will be available. How far we can go with short treatment duration remains to be studied (4, 6 or 8 weeks). Patients who failed previous treatment and developed resistance-associated variants (RAVS) to NS5A, should be rescued with future combinations (Asselah et al., 2018).
In this study, we aimed to investigate whether the glucose level improved and what factors affected the glucose improvement in patients with previous HCV infections who achieved an SVR, and we searched for the possible relation between SVR in HCV and improved glycemic control in 50 patients during their course of treatment by DAAs before treatment, at end of treatment and 3 months after finishing their treatment protocol.
The current study is a prospective cohort hospital-based study that aims to describe the association between T2DM on one hand and chronic HCV on the other hand after successful management of HCV through the DAAs according to the protocol of the Ministry of Health.
The study was conducted on 50 patients with T2DM and chronic HCV infection who were recruited from the outpatient clinics of the Health care facilities in El-Demerdash hospital and the National Research Center, depending on (Hashim et al., 2017) who found that the Mean±SD of HbA1c before and after HCV treatment were 7.11±0.88 and 6.77±0.98 respectively.
Comparison between patients who achieved SVR to others who did not achieve it regarding their HbA1c levels and Fasting Plasma Glucose were done to assess the possible correlation between successful management of HCV and improvement in their diabetic status.
SVR was defined as undetectable HCV RNA levels at 12 weeks after the end of treatment (EOT). Fasting plasma glucose (FPG) levels between 100–125 mg/dL were defined as prediabetes and FPG ≥ 126 mg/dL was defined as diabetes.
We have found positive correlation between management of HCV using DAAs in general and improvement of HbA1c and FPG; moreover, we reported stronger correlation between achieving SVR and the HbA1c level and FPG.
Comparison according to HCV PCR at month-3 after treatment end regarding baseline and follow ups HbA1c (%) showed that no significant differences according to HCV PCR at month-3 after treatment end regarding baseline HbA1c. HbA1c significantly decreased in negative and positive HCV PCR at treatment end and month-3 after treatment end. HbA1c at treatment end and month-3 after treatment end were significantly lower in cases with negative HCV PCR and HbA1c reductions at treatment end and month-3 after treatment end were significantly higher in cases with negative HCV PCR.
Comparison according to HCV PCR at month-3 after treatment end regarding Baseline and follow ups FPG (mg/dL) showed that no significant differences according to HCV PCR at month-3 after treatment end regarding baseline FPG. FPG significantly decreased in negative and positive HCV PCR at treatment end and month-3 after treatment end. FPG at treatment end and month-3 after treatment end were significantly lower in cases with negative HCV PCR. FPG reductions at treatment end and month-3 after treatment end were significantly higher in cases with negative HCV PCR.
While we did not note any change in the drugs used in treating T2D in our patients’ group and this may be caused by the short follow-up period (3months) post-treatment.
In conclusion, achieving SVR through DAAs improves the glycemic control of the T2D patients.
CONCLUSION
• In this study, we concluded that successful HCV eradication will result to a statistically significant reduction in fasting plasma glucose and HbA1c in patients with type 2 diabetes which is an indirect indicator of improvement of insulin sensitivity in patients with type 2 DM.
• This study had some limitations including lack of control group, relatively small sample size and short follow up period.
RECOMMENDATIONS
• A greater number of patients is recommended for a more precise information about the effect of glycemic control on insulin and OAD doses.
• More studies are need for identifying the different DAAs on the different HCV genotypes.
• Longer studies are needed for identifying the effect of DAAs on the T2D microvascular and macrovascular complications.