New research suggests cirrhosis, not HCV status, is the reason diabetes rates are higher among HCV-infected patients.
Firouze Bani-Sadr, MD, PhD
Among patients with HIV, hepatitis C (HCV) infection does not increase the risk with diabetes, but cirrhosis does, according to a new nationwide study in France.
Some previous research has shown increases in rates of diabetes among patients with HCV, but this new study adds clarity to the situation by looking at multiple factors beyond HCV status.
Firouzé Bani-Sadr, MD, PhD, of the University of Reims Champagne-Ardenne, in France, said the study is the first to take a holistic look at HCV as it relates to diabetes rates among people living with HIV.
“The major strength of our study was to evaluate, in the same analysis and—to the best of our knowledge—for the first time, not only HCV serology status or chronic HCV infection, but also major HCV covariates, in particular the duration of HCV infection and cirrhosis, which is a major confounding factor for DM,” Bani-Sadr told MD Magazine.
A number of other studies have shown no link between HCV status and diabetes. Among those that have drawn a link, such as a 2017 Italian study of diabetes prevalence among people living with HIV who had active HCV replication, cirrhosis was not evaluated.
One of Bani-Sadr’s study’s major strengths is its size. The data come from the Dat’AIDS cohort, a large national study of patients receiving treatment for HIV at 15 clinics across France. A total of 28,699 patients were included in this study. The data set included patients with a long duration of HIV and HCV infection, giving researchers a better sense of any long-term impacts of coinfection.
In addition to analyzing the data to find links between HCV and diabetes and HCV duration and diabetes, the team also looked at whether cirrhosis, history of interferon therapy, or sustaining virologic response could be tied to higher risk of diabetes.
Bani-Sadr and colleagues noted that previous studies, which have shown increases in diabetes among patients with HIV and HCV did not include cirrhosis in their analyses, even though cirrhosis is a well-established risk factor for diabetes. About 30% of cirrhosis patients (of any cause) have diabetes.
While a number of HIV-related factors, such as nadir CD4 cell count, duration of combination antiretroviral therapy (cART), and AIDS status were associated with higher diabetes risk. HCV, chronic HCV, and hepatitis B infection were not. Among the covariates, only cirrhosis showed an increased risk.
In short, the team found that, apart from HIV-related factors, patients with HCV have the same risk factors as the general population—body mass index and age.
Accordingly, Bani-Sadr said the research doesn’t suggest any changes are needed in the way physicians treat patients, except that it underscores the importance of early treatment of cirrhosis.
“They should prevent the progression of fibrosis and treat the aetiology of cirrhosis as soon as possible in order to prevent diabetes,” she said.
The study, “Risk of diabetes in HIV-infected patients is associated with cirrhosis but not with chronic HCV coinfection in a French nationwide HIV cohort,” was published online in Alimentary Pharmacology and Therapeutics.