Incidence of Diabetes in Hepatitis C Patients in Remote Areas of Pakistan: Effect of Co-Morbidity on HCV Treatment Outcomes at Selected Secondary Care Hospitals


Hepatitis C
Type II diabetes mellitus




The management of Hepatitis C (HCV) varies greatly due to co-morbidities. Association of Type II Diabetes Mellitus (T2DM) and HCV infection is momentous, however, only limited studies available from remote areas of Pakistan. This study aimed to assess the incidence of T2DM in Hepatitis C patients, and to measure the treatment outcomes of anti-HCV therapy in co-morbidity of diabetic patients in remote areas of Khyber Pakhtunkhwa Pakistan. A cross-sectional retrospective analysis of HCV patients (n=449) was conducted in the District Hospitals of Bannu and Lakki Marwat, Pakistan. Patients diagnosed of HCV infection and having T2DM as comorbidity were included in the study. The demographic information and laboratory parameters, such as viral load (VL), hemoglobin (Hb), alanine amino transferase (ALT), and platelet count were collected to measure treatment outcomes. T2DM was found in 33.18% of patients and significant association (p ? 0.05) was found with HCV infection as a co-morbidity. Sofosbuvir (SOF) and Ribavirin (RBV) therapy reduced the mean (SD) VL (x103) from baseline 357.1±26.23 IU /mL to 14±2.3 IU/mL and 1.3±0.3 IU/mL at 3rd and 6th months of therapy, respectively. Conventional Interferon and Ribavirin (RBV) therapy reduced VL from a baseline 234.57±13.5 IU/mL to 72±7.9 IU/mL and 62 ±3.7 IU/mL at 3rd and 6th months of therapy, respectively. PEG-Interferon+ Ribavirin (RBV) therapy reduced baseline VL from 337±16.27 IU/mL to 18±2.8 and 4±1 at 3rd and 6th month of therapy, respectively. Similarly, Hb, ALT, and platelet count showed variations in all the studied groups. T2DM was highly prevalent and significantly associated with HCV in patients of 40 years or above and SOF+RBV combination therapy showed a better response, both in the diabetic and non-diabetic HCV patients compared to earlier the therapies. To further confirm the finding, a study using a larger population of HCV patients with T2DM should be conducted.


Irshad M, Mankotia DS, Irshad K, 2013, An Insight into the Diagnosis and Pathogenesis of Hepatitis C Virus Infection. World J Gastroenterol, 2013(19): 7896–7899.

Li HC, Lo SY, 2015, Hepatitis C Virus: Virology, Diagnosis and Treatment. World J Hepatol, 2015(7): 1377–1379.

Saleha S, Kamal UF, Khan N, et al., 2014, Prevalence of Hepatitis C Virus Genotypes in District Bannu, Khyber Pakhtunkhwa, Pakistan. Hepat Res Treat, 2014(3): 24–28.

Anwar MI, Rahman M, Hassan MU, et al., 2013, Prevalence of Active Hepatitis C Virus Infections among General Public of Lahore, Pakistan. Virol J, 2013(10): 351–54.

Attaullah SK, Ali I, 2011, Hepatitis C Virus Genotypes in Pakistan: A Systemic Review. Virol J, 2011(8): 433–438.

Umer M, Iqbal M, 2016, Hepatitis C Virus Prevalence and Genotype Distribution in Pakistan: Comprehensive Review of Recent Data. World J Gastroenterol, 2016(22): 1684–1687.

Louie KS, Laurent SS, Forssen UM, et al., 2012, The High Comorbidity Burden of the Hepatitis C Virus Infected Population in the United States. BMC Infect Dis, 2012(12): 86–89.

El-Zayadi R, 2009, Hepatitis C Comorbidities Affecting the Course and Response to Therapy. World J Gastroenterol, 2009(15): 4993–4999.

Alaei M, Negro F, 2008, Hepatitis C Virus and Glucose and Lipid Metabolism. Diabetes Metab, 3(4): 692–700.

Aytug S, Reich D, Sapiro LE, et al., 2003, Impaired Irs?1/Pi3?Kinase Signalling in Patients with HCV: A Mechanism for Increased Prevalence of Type 2 Diabetes. Hepatology, 2003(38): 1384–1392.

Allison ME, Wreghitt T, Palmer CR, et al., 1994. Evidence for a Link between Hepatitis C Virus Infection and Diabetes Mellitus in a Cirrhotic Population. J Hepatol, 1994(21): 1135–1139.

Imazeki F, Yokosuka O, Fukai K, et al., 2008, Prevalence of Diabetes Mellitus and Insulin Resistance in Patients with Chronic Hepatitis C: Comparison with Hepatitis B Virus?Infected and Hepatitis C Virus?Cleared Patients. Liver Int, 2008(28): 355–362.

Mehta SH, Brancati FL, Sulkowski MS, et al., 2000, Prevalence of Type 2 Diabetes Mellitus Among Persons with Hepatitis C Virus Infection in The United States. Annals Internal Med, 2000(133): 592–599.

Allison ME, Wreghitt T, Palmer CR, et al., 1994, Evidence for a Link between Hepatitis C Virus Infection and Diabetes Mellitus in a Cirrhotic Population. J Hepatol, 1994(21): 1135–1139.

Memon MS, Arain ZI, Naz F, et al., 2013, Prevalence of Type 2 Diabetes Mellitus in Hepatitis C Virus Infected Population: A Southeast Asian Study. J Diabetes Res, 2013(4): 36–39.

White DL, Ratziu V, El-Serag HB, 2008, Hepatitis C Infection and Risk of Diabetes: A Systematic Review and Meta-Analysis. J Hepatol, 2008(49): 831–844.

Costantini S, Capone F, Guerriero E, et al., 2012, Cytokine Profile of Patients with Type 2 Diabetes and Chronic Hepatitis C Infection. Plos One, 2012(7): E39486.

Hsu YC, Lin JT, Ho HJ, et al., 2014, Antiviral Treatment for Hepatitis C Virus Infection Is Associated with Improved Renal and Cardiovascular Outcomes in Diabetic Patients. Hepatology, 59: 1293–1302.