Glycemic control after HCV eradication with IFN-free therapy in HIV co-infected patients with glycemic disorders

Abstract

Objectives: HCV infection promotes insulin resistance. Glycemic parameters improve after sustained virological response (SVR) with both interferon-based and interferon-free regimens in HCV mono-infection, with very few data in HIV/HCV co-infection. We analyze biochemical tests after SVR with all-oral direct-acting antiviral (DAA) in HIV/HCV co-infected patients previously diagnosed with impaired fasting glucose (IFG) or type 2 diabetes mellitus (DM2).

Methods: HIV/HCV patients of the cohort “VIH-DOC” were eligible if treated with DAA between 9th January 2015 and 31st August 2016, diagnosed with IFG or DM2 before therapy, and achieved SVR24. Fasting plasma glucose (FPG) was collected at baseline, end of therapy (EOT) and SVR24. Glycated Haemoglobin (HbA1c) and body weight (BW) were registered at baseline and 24-48 months after EOT for patients with DM2. Means were compared with the repeated measures ANOVA test or the T-Student test.

Results: DAA therapy was received by 116 patients with IFG or DM2. SVR24 was confirmed in 109 (93.97%). Table 1

Age: mean (years) (SD) 52.0 (4.7) Gender: n (%) Male / Female 90 (82.6) / 19 (17.4) Time since HIV infection diagnosis: median (years) (IQR) 23.5 (21.1 - 26.2) Time since HCV infection or diagnosis: median (years) (IQR) 28.6 (23.3 - 32.5) Basal HCV-RNA: median (UI/mL) (IQR) 1765728 (675692 - 4215662) Basal liver stiffness estimated by transient elastography: median (kPa) (IQR) 12.1 (8.0 - 20.6) Glycemic disorder: n (%) Impaired fasting glucose / Type 2 diabetes mellitus 54 (49.5) / 55 (50.5) Basal plasma fasting glucose: median (IQR) 117 (105.5 - 145.5) Basal glycated haemoglobin HbA1c: median (IQR) 6.3 (5.8 - 7.7) Basal body mass index: median (IQR) 26.0 (23.1 - 28.6) [Table 1: Baseline characteristics]

shows baseline characteristics. FPG was lower at SVR24 vs. baseline both in the whole population (122.7 mg/dL vs. 135.1 mg/dL, p=0.026) and in patients with DM2 only (133.9 mg/dL vs. 155.7 mg/dL, p=0.039). The latter experienced no improvement on HbA1c when comparing baseline vs. SVR24 (6.60% vs. 6.32%. Mean change: 0.28, 95% CI: -0.07 - 0.63, p=0.119), and BW did not increase at SRV24 vs. baseline (78.89 kg vs. 78.48 kg. Mean change: 0.41, 95% CI: -0.87 - 1.68, p=0.524).

While on treatment, hyperglycemic decompensations were identified in 8 patients and hypoglycemia in another one, without other clinical complications.

Conclusion: FPG improves after SVR24 on HIV/HCV co-infected patients with IFG and DM2, but HBA1c remained unchanged. This could be explained by a relatively good glycemic control pre-therapy.