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

Abstract

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 3^rd and 6^th 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 3^rd and 6^th 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 3^rd and 6^th 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.