Departments of Endemic Medicine and Hepatology.
Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(12):1588-1594. doi: 10.1097/MEG.0000000000001903.
To evaluate the effect of generic sofosbuvir and daclatasvir (SOF/DCV) treatment on the glycemic state and insulin resistance as well as lipid profiles of those who achieved sustained virological response (SVR) in diabetic chronic hepatitis C virus (CHC) patients.
We retrospectively reviewed 114 CHC patients with evidence of type 2 diabetes that were treated with generic SOF/DCV between May 2016 and August 2017. Baseline demographic and laboratory data were recorded. At 12-week post end of therapy (SVR12), glycemic state and insulin resistance as well as lipid profiles were re-evaluated and compared with baseline.
A total of 98 diabetic CHC patients were finally included and were responders. A significant decline in the glycemic state as well as Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values (P ≤ 0.0001) was observed, but HOMA-S showed a statistically significant increase (P ≤ 0.0001) at SVR12 in comparison to baseline values. Also, a significant increase in serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol levels was observed at SVR12 compared to baseline, but serum triglycerides levels showed a significant decrease. Logistic regression showed that the higher baseline HOMA-IR was a significant predictive variable of a decrease ≥20% of HOMA-IR, while higher baseline HOMA-IR and baseline triglycerides emerged as the only significant predictors of the Δ increase LDL-C level at SVR12.
SOF/DCV-based therapy led to an improvement of glycemic state associated with a global worsening of lipid profile. Further studies are strongly warranted to evaluate the cardiovascular balance between amelioration of insulin resistance and negative changes of the lipid profile.
评估普通索菲布韦和达拉他韦（SOF/DCV）治疗对获得慢性丙型肝炎病毒（CHC）合并糖尿病患者持续病毒学应答（SVR）患者的血糖状态和胰岛素抵抗以及血脂谱的影响。
我们回顾性分析了 2016 年 5 月至 2017 年 8 月期间接受普通 SOF/DCV 治疗的 114 例 CHC 合并糖尿病患者的证据。记录了基线人口统计学和实验室数据。在治疗结束后 12 周（SVR12）时，重新评估了血糖状态和胰岛素抵抗以及血脂谱，并与基线进行了比较。
共纳入 98 例糖尿病 CHC 患者，均为应答者。与基线相比，SVR12 时血糖状态以及稳态模型评估的胰岛素抵抗（HOMA-IR）值显著下降（P≤0.0001），但 HOMA-S 显著增加（P≤0.0001）。此外，与基线相比，SVR12 时血清总胆固醇、低密度脂蛋白（LDL）-胆固醇和高密度脂蛋白（HDL）-胆固醇水平显著升高，但血清甘油三酯水平显著下降。Logistic 回归显示，较高的基线 HOMA-IR 是 HOMA-IR 下降≥20%的显著预测变量，而较高的基线 HOMA-IR 和基线甘油三酯是 SVR12 时 LDL-C 水平增加的唯一显著预测变量。
SOF/DCV 为基础的治疗导致血糖状态改善，同时血脂谱全面恶化。强烈需要进一步研究来评估改善胰岛素抵抗和血脂谱负性变化之间的心血管平衡。
