An in-hospital referral program for hepatitis C virus elimination in patients with type 2 diabetes mellitus

The World Health Organization's goal of hepatitis C virus (HCV) elimination by 2030 remains a challenge. While type 2 diabetes mellitus (T2DM) is associated with HCV infection, identifying unrecognized cases in low-endemic areas is difficult. This study evaluates the feasibility and outcomes of a hospital-based microelimination referral program in T2DM patients and explores chronic kidney disease (CKD) stage as a potential risk stratifier.

In this prospective study (March 2022-May 2023), T2DM patients enrolled in a pay-for-performance program underwent routine anti-HCV antibody screening. Seropositive patients were referred to hepatologists for HCV-RNA testing and direct-acting antiviral (DAA) evaluation. We used multivariable logistic regression to identify baseline predictors of HCV viremia and piecewise generalized estimating equations (GEE) to assess the impact of viremia and DAA therapy on estimated glomerular filtration rate (eGFR) trajectories.

Among 4402 T2DM patients, 104 (2.4%) were anti-HCV positive. Seroprevalence increased across CKD stages 1 to 5 (1.8%, 2.3%, 2.6%, 3.5%, and 7.8%; p = 0.014). Furthermore, among anti-HCV-positive patients, the proportion of advanced CKD (stages 3-5) significantly increased in those with higher Fibrosis-4 (FIB-4) index scores ( p = 0.020). Multivariable analysis of HCV viremia identified lower diastolic blood pressure (odds ratio [OR], 0.968; p = 0.017), total cholesterol (OR, 1.012; p = 0.015), triglycerides (OR, 0.991; p = 0.008), and alanine aminotransferase (OR, 1.011; p = 0.006) as independent predictors. While untreated viremia initially appeared to accelerate eGFR decline, this effect was attenuated after adjusting for age and glycated hemoglobin (HbA1c). Moreover, eGFR decline trajectories did not change significantly following DAA therapy.

An in-hospital referral program for T2DM patients is feasible for HCV microelimination, using CKD staging as a practical risk stratifier. Despite DAA renal safety, diabetes-associated kidney damage may drive post-cure renal progression, necessitating continuous metabolic management.