HCV eradication with DAAs cuts insulin resistance

  • Russo FP & al.
  • J Viral Hepat
  • 9 Oct 2019

  • International Clinical Digest
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Takeaway

  • HCV eradication with direct-acting antivirals (DAAs) leads to a significant reduction in insulin resistance (IR), even among patients with cirrhosis.
  • IR may persist among patients with high BMI.

Why this matters

  • IR is a major metabolic manifestation of HCV that favors development of steatosis and nonalcoholic fatty liver disease, risk factors for fibrosis progression and hepatocellular carcinoma.

Study design

  • Prospective study of 138 patients (mean age, 58 years; 62% male) with HCV (genotype 1, 63.0%) treated with DAAs in 3 Italian tertiary-care centres.
  • 68.8% were cirrhotic (Child A, 91.6%) and 29.7% were treatment-experienced.
  • IR defined as homeostasis model assessment index (HOMA)-IR ≥2.5.
  • Funding: None.

Key results

  • 68.1% of patients had IR at baseline, which was associated with:
    • Higher liver stiffness on fibroscan (23±12 vs 15±8 kPa; P<.001>
    • Greater prevalence of cirrhosis (n=77 vs 18; P=.003).
  • 135 patients (97.8%) achieved sustained virological response at 12 weeks posttherapy.
  • IR prevalence was reduced at 24 weeks (n=128: 56.2%; P=.04), and further reduced at 48 weeks (n=124: 49%; P=.01).
  • HOMA-IR was significantly lower at week 48 vs baseline (1.8 vs 3.0; P<.001 reflecting lower insulin levels vs mu>
  • Elevated BMI was tied to lower odds of achieving non-IR status at weeks 24 (P=.05) and 48 (P=.04).

Limitations

  • Short follow-up.