HCV: SVR tied to fewer T2DM complications

  • Li J & al.
  • Aliment Pharmacol Ther
  • 16 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Successful HCV clearance among patients with type 2 diabetes mellitus (T2DM) is associated with significantly reduced odds of acute coronary syndrome (ACS), end-stage renal disease (ESRD), ischemic stroke, and retinopathy.
  • Benefit observed independent of cirrhosis status.

Why this matters

  • Despite the complex interrelationship of HCV and diabetes, the effect of antiviral therapy on diabetes-related complications has remained largely unknown.

Study design

  • Data for 1395 HCV-infected patients with T2DM (mean age, 59.4 years) obtained from the 2006-2016 Chronic Hepatitis Cohort Study (CHeCS); 441 were cirrhotic.
  • 52% received interferon (IFN) or direct-acting antiviral (DAA) regimens; rate of sustained virologic response at 12 weeks posttherapy (SVR12), 75%.
  • Median follow-up: 2.7 years for ACS, ESRD, and stroke; 2.4 years for retinopathy.
  • Funding: CHeCS is funded by the CDC and Gilead Pharmaceuticals.

Key results

  • After propensity-score adjustment for selection bias, SVR12 significantly reduced risk for complications vs no treatment (all P<.001>
  • ACS: subHR (sHR)=0.36.
  • ESRD: sHR=0.46.
  • Stroke: sHR=0.34.
  • Retinopathy: sHR=0.24.
  • Restricting analysis to patients with cirrhosis:
    • ACS: sHR=0.10 (P<.001>
    • ESRD: sHR=0.31 (P=.003).
    • Stroke: sHR=0.26 (P=.008).
    • Retinopathy: sHR=0.39 (P=.006).
  • Benefits also observed with SVR via IFN-based therapy when restricting analysis to patients with cirrhosis and excluding those with on-treatment retinopathy.
  • Limitations

    • Observational data, reliance on ICD9/10 codes.

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