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From Cure to Complexity: Post-SVR Liver and Metabolic Trajectories in Diabetic Patients
Clelia Asero1,2, Maria Stella Franzè2, Teresa Maltese1
1Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Summary
Hepatitis C cure with DAAs improves metabolic and liver health in type 2 diabetes patients. However, long-term outcomes depend on initial liver disease severity, insulin resistance, and genetics, highlighting the need for early treatment and management.
Area of Science:
- Hepatology
- Endocrinology
- Genetics
Background:
- The long-term impact of Hepatitis C Virus (HCV) cure on hepatic and metabolic outcomes in patients with type 2 diabetes (T2D) is not well-defined.
- This study investigates the effects of direct-acting antivirals (DAAs) on T2D-related vascular complications, liver disease progression, and overall survival.
Purpose of the Study:
- To evaluate the long-term hepatic and metabolic outcomes in T2D patients after HCV cure.
- To identify predictors of liver disease progression and vascular complications.
- To explore the contribution of genetic variability to patient outcomes.
Main Methods:
- Prospective follow-up of 183 T2D patients with HCV treated with DAAs.
- Collection of demographic, biochemical, and clinical data over a median of 48 months.
- Assessment of genetic variants (PNPLA3, TM6SF2, MBOAT7) and application of regression models.
Main Results:
- Significant improvements in HbA1c, liver stiffness, and liver enzymes were observed post-HCV cure.
- Liver disease progression occurred in 20.8% of patients, linked to cirrhosis, prior decompensation, and the MBOAT7 variant.
- Macrovascular and microvascular complications developed in 50.8% and 33.9% of patients, respectively, often within two years of sustained virologic response (SVR).
Conclusions:
- DAAs improve metabolic and hepatic parameters in T2D patients with HCV.
- Long-term prognosis is influenced by baseline liver disease severity, insulin resistance, and genetic factors.
- Early antiviral treatment and optimized metabolic management are crucial for this high-risk population.
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