Original Research

Significant HbA1c Lowering in Patients Achieving a Hepatitis C Virus Cure

Fed Pract. 2019 March;36(suppl 2):S26-S32

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Finally, hemoglobin was not collected to account for any impact ribavirin-associated anemia may have had on the immediate posttreatment HbA_1cvalues. Phase 3 DAA trials have demonstrated that between 7% and 9% of patients on ribavirin-containing DAA regimens are expected to have a hemoglobin < 10 g/dL during the HCV treatment course.^33-36 Ribavirin-containing regimens may minimally impact the immediate posttreatment HbA_1c result, but not necessarily the 12- or 18-month posttreatment HbA_1c levels due to the reversible nature of this adverse effect (AE) following discontinuation of ribavirin.

Future studies may be strengthened by controlling for possible confounders such as concomitant ribavirin, adherence to antihyperglycemic medications, comorbidities, years since initial DM diagnosis, and lifestyle modifications, including a decrease of alcohol consumption. A prospective study also may include data on hypoglycemic events and further determine the sustained response by including an 18- or 24-month posttreatment HbA_1c in the protocol.

Conclusion

The findings of this study validate the significant HbA_1c changes post-HCV treatment described in the recent veteran database study.³² However, the current study’s validated patient chart data provide a better understanding of the changes made to antihyperglycemic regimens. This also is the first study describing this phenomenon of improved insulin resistance to only be observed in approximately 80% of patients infected with HCV and comorbid T2DM. Furthermore, the variable magnitude of HbA_1c impact reliant on baseline HbA_1c is informative for individual patient management. In addition to the direct benefits for the liver on hepatitis C viral eradication, improvements in HbA_1c and the de-escalation of antihyperglycemic regimens may be a benefit of receiving HCV treatment.

The improved DM control achieved with hepatitis C viral eradication may represent an opportunity to prevent progressive DM and cardiovascular AEs. Additionally, HCV treatment may be able to prevent the onset of T2DM in patients at risk. Arguably HCV treatment has significant benefits in terms of health outcomes, quality of life, and long-term cost avoidance to patients beyond the well-described value of decreasing liver-related morbidity and mortality. This may be an incentive for payers to improve access to HCV DAAs by expanding eligibility criteria beyond those with advanced fibrotic liver disease.

Acknowledgments
This material is the result of work supported with the resources and the use of facilities at the VA Northeast Ohio Healthcare System.