Antivirals May Help Those With Diabetes and Hepatitis

Diabetes patients with hepatitis C may improve kidney and cardiovascular results with antiviral Rx

(RxWiki News) Patients with the hepatitis C virus (HCV), which primarily affects the liver, face a higher chance of getting diabetes. Antiviral HCV medication, however, may improve diabetes outcomes.

About 3.2 million people in the US have chronic HCV, according the Centers for Disease Control and Prevention. Some studies have shown that HCV may trigger diabetes.

Researchers in Taiwan recently found that individuals who have both HCV and diabetes may reduce incidences of kidney disease, stroke and heart attack if they take antiviral therapy.

"Get tested for hepatitis C as part of a complete checkup."

Chun-Ying Wu, MD, professor of medicine at National Yang-Ming University and with Taichung Veterans General Hospital in Taiwan, led this study, which analyzed data on individuals with both diabetes and HCV from the Taiwan National Health Insurance Research Database.

The researchers identified 1,411 of these patients who received pegylated interferon plus ribavirin and another 1,411 who had diabetes and HCV but did not receive this antiviral therapy. They also evaluated medical information on 5,644 patients with diabetes who did not have HCV and hence did not receive the HCV therapy.

Interferon is a protein made by the immune system, and it is so named because it interferes with viral reproduction. Ribavirin is not effective against HCV when taken alone, but it raises cure rates and reduces the chance of relapse when taken with interferon.

After a follow-up of eight years, these researchers observed that patients in the treatment group fared best in terms of kidney disease and cardiovascular disease outcomes.

End-stage renal (kidney) disease affected 1.1 percent of the treated patients, but 9.3 percent of the untreated and 3.3 percent of the non-HCV infected.

About 3 percent of the treated patients had strokes, while 5.3 percent of the untreated and 6 percent of the uninfected had strokes.

Heart attacks or angina were less common among the treated as well, with 4.1 percent experiencing these outcomes, compared to 6.6 percent of the untreated and 7.4 percent of the uninfected.

Because this study did not include patients who had HCV but no diabetes, the authors are planning to conduct another population-based cohort study to examine whether the antiviral therapy will reduce renal and cardiovascular outcomes in this population, according to Dr. Wu.

"It turns out that diabetes accounts for nearly half of all cases of kidney failure in the US and up to 15 percent of patients with kidney failure have evidence of Hepatitis C infection," said Allen R. Nissenson, MD, FACP, Chief Medical Officer at DaVita HealthCare Partners Inc. and Emeritus Professor of Medicine at the David Geffen School of Medicine at UCLA.

"Identifying patients early in their course, before they start dialysis, and treating with anti-viral medications offers great promise to slow the rate of progression of the kidney disease, and possibly delay the need for dialysis," Dr. Nissenson told dailyRx News.

"As with any treatment the risks of the medication must be weighed against the benefits, and patients along with their doctors should decide the best course of action for them," he said.

Dr. Wu told dailyRx News, “For those who have diabetes and are infected with HCV, we suggest that they discuss with their doctors about the usefulness of antiviral therapy and the possibility to reduce their renal and cardiovascular adverse outcomes.”

The US Preventive Services Task Force says that many people are unaware that they have HCV because they have no symptoms. The organization recommends a one-time screening for “baby boomers” (born between 1945 and 1965) and strongly encourages those who have used injectable drugs or had a blood transfusion before 1992 to be tested.

This study was published in December in Hepatology, a journal of the American Association for the Study of Liver Diseases. The research was funded in part by grants from Taiwan’s National Health Research Institutes and Taiwan’s National Science Council.

Review Date: 
December 16, 2013