Antivirals improve renal, CV outcomes in patients with HCV and diabetes

Antivirals improve renal, CV outcomes in patients with HCV and diabetes
Antivirals improve renal, CV outcomes in patients with HCV and diabetes

Antiviral treatment for hepatitis C infection led to improvements in renal and cardiovascular outcomes in patients with diabetes, results of a population-based cohort study indicate.

“Risks for end-stage renal disease, ischemic stroke and acute coronary syndrome are significantly reduced in HCV-infected patients who received antiviral therapy when compared with untreated controls,” Chun-Ying Wu, MD, PhD, MPH, of Taichung Veterans General Hospital in Taichung, Taiwan, and colleagues reported in Hepatology.

The researchers set out to examine whether antiviral therapy for HCV was associated with improved outcomes in a cohort of 1,411 individuals diagnosed with diabetes included in the Taiwan National Health Insurance Research Database between 2003 and 2011.

Patients were treated with pegylated interferon plus ribavirin and matched 1:1 with 1,411 untreated controls. Those treated with pegylated interferon plus ribavirin were also matched 1:4 with 5,644 patients with diabetes but without HCV.

Primary outcome measures were end-stage renal disease (ESRD), ischemic stroke and acute coronary syndrome (ACS) after receiving antiviral treatment or the corresponding calendar date.

The eight-year cumulative incidence for ESRD among the treated cohort was 1.1%, 9.3% among the untreated cohort and 3.3% among those without HCV (P<.001).

The cumulative incidence for stroke among the treated cohort was 3.1%, compared with 5.3% in  the untreated cohort and 6.1% in those without HCV (P=0.01).

The incidence for ACS was 4.1 among those who were treated compared with 6.6% among those who were not treated and 7.4% among those without HCV (P=0.05).

Compared with untreated patients, those who received antiviral HCV therapy had the following multivariate-adjusted hazard ratios:

  • End-stage renal disease, HR=0.16 (95% CI: 0.07-0.33)
  • Ischemic stroke, HR=0.53 (95% CI: 0.30-0.93)
  • Acute coronary syndrome, HR=0.64 (95% CI: 0.39-1.06)

“These findings implicate that HCV infection may have a pathogenic role in the development of clinical complications related to diabetes,” the researchers wrote. “The causal relationship and pathophysiological mechanisms underlying this association warrant further research.”

References

  1. Hsu YC. Hepatology. 2013; doi: 10.1002/hep.26892.

Disclosure: Yao-Chun Hsu reports receiving lecture fees from the Merck Sharp & Dohme and Roche.

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