P-33 IMPACT OF SUSTAINED VIROLOGIC RESPONSE ON GLUCOSE PARAMETERS AMONG CHRONIC HEPATITIS C PATIENTS TREATED WITH DIRECT ACTING ANTIVIRALS

Abstract

Introduction and Objectives: Sustained virological response (SVR) of hepatitis C virus (HCV) with direct acting antivirals (DAAs) improve survival and reduces progression to cirrhosis, decompensation and hepatocellular carcinoma. Glucose metabolism impairment is one of the most frequent extra-hepatic manifestations of chronic HCV infection. The impact of SVR on glycemic parameters and baseline variables associated with this outcome remains uncertain. This study aimed to evaluate glucose metabolism before and after SVR, as well as investigate the presence of baseline characteristics related to improvement in glycemic control. Materials and Methods: Prospective study of chronic HCV infection patients treated with DAAs between January 2016 and December 2017 at Viral Hepatitis Outpatient Clinic of Hospital de Clinicas de Porto Alegre, Brazil. Inclusion criteria were SVR to DAA therapy with follow-up for at least 24 weeks after the end of therapy. The exclusion criteria were the presence of other etiology of liver disease. Glycated hemoglobin (A1C) was analyzed before and after treatment in all patients. Subgroups were stratified by cirrhosis, genotype, BMI, age and presence or absence of baseline glycemic disorder. The primary outcome was a change in glycemic homeostasis after HCV eradication without a change in pharmacologic therapy with an impact on glycemic control. Secondary outcomes were baseline variables associated with improvement of glucose control. Results: A total of 207 patients were included, with a mean age of 60.6±10.7 years. Forty-eight percent were males. Cirrhosis was found in 56% and genotype 3 in 37% of patients. T2DM or PD at baseline was present in 54.5%. Overall, median A1C at baseline reduced significantly after SVR (5.7, IQR 5.3-6.7 to 5.5, IQR 4.9-6.3, respectively, p=0.01). Baseline characteristics associated with statistically significant improvement in glycemic control after SVR were cirrhosis, genotype 3 and age below 60 years old. Conclusions: SVR with DAAs was associated with improved glycemic control, particularly among patients with cirrhosis, genotype 3 and/or age below 60 years old.