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Abstract Details
Nonalcoholic Fatty Liver Disease Risk Factors Affect Liver-Related Outcomes After Direct-Acting Antiviral Treatment for Hepatitis C
Jihane N Benhammou12, Andrew M Moon3, Joseph R Pisegna4, Feng Su5, Philip Vutien5, Cynthia A Moylan67, George N Ioannou389
Author information
1Pfleger Liver Institute, University of California Los Angeles, 200 Medical Plaza, Los Angeles, CA, 90095, USA.
2Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA.
3Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building CB#7080, Chapel Hill, NC, 27599-7080, USA.
4Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA.
5Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA.
6Division of Gastroenterology, Veterans Affairs Health System, Durham, NC, USA.
7Division of Gastroenterology, Duke University Health System, 905 Lasalle St., Gsrb 1 DUMC 3256, Durham, NC, 27710, USA.
8Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, S-111-Gastro, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
9Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System, S-111-Gastro, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
Abstract
Introduction: In hepatitis C (HCV) patients, obesity and/or diabetes may increase the risk of liver-related outcomes. We aimed to determine whether diabetes and/or obesity are associated with adverse outcomes in direct-acting antiviral (DAA)-treated HCV patients.
Methods: We conducted a retrospective study of 33,003 HCV-infected, DAA-treated Veterans between 2013 and 2015. Body mass index was used to categorize patients into underweight (< 18.5 kg/m2), normal weight (18.5 to < 25 kg/m2), overweight (25 to < 30 kg/m2), obesity I (30 to < 35 kg/m2), and obesity II-III (> 35 kg/m2). Diabetes was defined by ICD-9/10 codes in association with hemoglobin A1c > 6.5% or medication prescriptions. Patients were followed from 180 days post-DAA initiation until 2/14/2019 to assess for development of cirrhosis, decompensations, hepatocellular carcinoma (HCC), and death. Multivariable Cox proportional hazards regression models were used to determine the association between diabetes and/or obesity and outcomes.
Results: During a mean follow-up of 3 years, 10.1% patients died, 5.0% were newly diagnosed with cirrhosis, 4.7% had a decompensation and 4.0% developed HCC. Diabetes was associated with an increased risk of mortality (AHR = 1.25, 95% CI 1.10-1.42), cirrhosis (AHR = 1.31, 95% CI 1.16-1.48), decompensation (AHR = 1.74, 95% CI 1.31-2.31), and HCC (AHR = 1.32, 95% CI 1.01-1.72) among patients without baseline cirrhosis. Compared to normal-weight persons, obese persons had a higher risk of cirrhosis, but overweight and obese persons had lower risk of mortality and HCC.
Conclusions: In this large DAA-treated Veterans cohort, pre-DAA diabetes increases mortality and liver-related events independent of SVR. Continued vigilance is warranted in patients with diabetes despite SVR. Elevated BMI categories appear to have improved outcomes, although further studies are needed to understand those associations.