Hepatitis C virus eradication with direct acting antiviral improves insulin resistance

Sustained virological response (SVR) after interferon-based therapy is associated with improvement of insulin resistance (IR) in HCV infected patients. Few data are available in the direct-acting antivirals (DAAs) era, especially in cirrhotic patients. We prospectively evaluated the long-term effect of DAAs on IR. Patients treated with DAAs between May 2015 and December 2016 in 3 tertiary care centers were recruited. Patients with diabetes were excluded. Biochemical and virological data were collected at baseline, 12/24/48-weeks (W) after the end of therapy (EOT). Presence of IR was defined by a "homeostasis model assessment index for IR" [HOMA-IR]) > 2.5. Liver fibroscan was performed at baseline, at 24/48W after EOT. 138 patients were enrolled (mean age 58 years, M/F 85/53, GT1 61%, 68.8% cirrhotic). Sixty-eight (94/138) had IR. Patients with IR had significantly higher stiffness than patients without it (23±12 vs. 15±8; p <0.0001). SVR12 was achieved in 135 (98%) patients, and 124 (90%) patients reached the 48W post-EOT. At this time-point, the percentage of patients with IR significantly decreased to 49% (p=0,01). HOMA-IR was significantly lower than baseline (1.8 vs. 3; p<0.001), and this was related to a significant reduction of insulin level (11.7±6.3 vs 16.4±8.3). High BMI was associated with a significantly lower probability of achieving a non-IR status at 24W (p=0.05) and 48W (p=0.03). IN CONCLUSION: SVR following DAAs led to a significant reduction of IR, even in patients with cirrhosis. Nevertheless, IR can persist after the achievement of SVR, especially in patients with high BMI.