Glucose and Lipid Profile Changes in Hepatitis C Patients After Direct Acting Antivirals Therapy

Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. Chronic HCV infection is associated with development of insulin resistance and therefore type 2 Diabetes mellitus (T2DM), it is also associated with hepatic steatosis and hypocholesterolemia. The treatment by Direct Acting Antivirals (DAAs) leads to sustained virological response (SVR) in almost all infected patients and decreases liver-related as well as all-cause mortality in these patients. The evidence for the effect of DAAs therapy on T2DM is quite conflicting. Some studies agreed with the glucometabolic amelioration induced by the Sustained Virological Response (SVR) but other studies disagreed with this hypothesis. The aim of the work was to evaluate glucose and Lipid Profile changes in hepatitis C patients at 12 weeks post treatment (SVR12) by Direct Acting Antivirals Therapy.

Methods: This prospective study was carried out on 80 chronic HCV infected patients who are treatment naïve and subjected to HCV DAAs treatment (Daclatasvir + Sofosbuvir for 12 weeks +/- Ribavirin or any DAA available) with 100% SVR rate at 12 weeks with no relapse. All patients are subjected to assessment of Fasting blood glucose, HbA1C and assessment of Lipid profile; Total cholesterol, Triglycerides, HDL, LDL at baseline (pretreatment) and at end of treatment then they are followed up at SVR12.

Results: Average HbA1C, fasting blood glucose has significantly decreased in group A diabetic patients from baseline to end of treatment and to SVR12, Average Total Cholesterol, LDL has significantly increased in group A and B from baseline to end of treatment and to SVR12 respectively. Average Triglycerides has significantly decreased from baseline to end of treatment in group A and B and to SVR12 in group A only. Average HDL has significantly increased only in group B non-diabetics from baseline to end of treatment and to SVR12.

Conclusions: Successful clearance of HCV viremia (SVR12) with DAAs treatment has been associated with significant Improvement or decrease of HbA1c and Fasting plasma glucose levels in diabetic chronic HCV infected patients, and has been associated with Rise in the Lipid profile; Total Cholesterol, LDL, HDL (non-diabetics only) while it decreases Triglycerides in both diabetic and non-diabetic chronic HCV infected patients.