Reversal of insulin resistance by HCV clearance through direct-acting antiviral treatments in chronic hepatitis C patients.

Objective: To assess the effect of direct active antiviral treatment on insulin resistance reversal in hepatitis C genotype 3 patients achieving sustained virologic response. Study Design: Case-control study. Setting: Department of Medicine, Nishtar Medical Hospital, Multan. Period: May 2024 to October 2024. Methods: A total of 100 hepatitis C genotype 3 patients with advanced liver fibrosis being considered for treatment with DAAs were selected for study. Patients were divided into cases i.e. 50 patients treated with DAAs and the control group i.e. 50 patients left untreated. Blood plasma and serum samples were collected prior to treatment initiation, after treatment completion, and at 3-month follow-up to check insulin and glucose levels in cases. In the control group, patients were assessed at the start of the study (Time 0) and at the 3-month follow-up. Results: HCV clearance was achieved in all patients and 47 patients (94%) achieved SVR. Hepatic stiffness in cases was 20.07 ± 10.21 kPa before the start of treatment and 19.78 ± 8.5 after treatment and significantly lower at follow-up (13.34 ± 7.9) (p<0.001). A significant association between HOMA-IR and HCV-RNA levels was noted at baseline and a trend was found for hepatic stiffness (p=0.069) and BMI (p=0.060). Conclusion: HCV clearance through direct-acting anti-viral treatment improves or reverses insulin resistance in Hepatitis C genotype III patients reducing the risk of diabetes mellitus, advanced liver fibrosis metabolic syndrome, and cardiovascular events.