Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients

Yao Chun Hsu, Jaw Town Lin, Hsiu J. Ho, Yu Hsi Kao, Yen Tsung Huang, Nai Wan Hsiao, Ming Shiang Wu, Yi Ya Liu, Chun Ying Wu

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Abstract

Hepatitis C virus (HCV) infection is causally associated with insulin resistance and diabetes mellitus. This population-based cohort study aimed to investigate whether antiviral therapy for HCV infection was associated with improved clinical outcomes related to diabetes. From the Taiwan National Health Insurance Research Database, 2,267,270 Taiwanese residents diagnosed with diabetes mellitus were screened for eligibility. HCV infection was defined by a specific diagnosis code and measurement of serum antibody. After excluding patients with serious comorbidity, we enrolled a total of 1,411 eligible patients who received pegylated interferon plus ribavirin (treated cohort), and matched them 1:1 with 1,411 untreated controls by propensity scores (untreated cohort). We also matched the treated cohort 1:4 with 5,644 diabetic patients without HCV infection (uninfected cohort). Participants were followed up for the occurrence of endstage renal disease (ESRD), ischemic stroke, and acute coronary syndrome (ACS) after receiving antiviral treatment or the corresponding calendar date. From 2003 to 2011, the 8-year cumulative incidences of ESRD in the treated, untreated, and uninfected cohorts were 1.1% (95% confidence interval [CI], 0.3-2.0%), 9.3% (95% CI, 5.9-12.7%), and 3.3% (95% CI, 2.3-4.3%), respectively (P < 0.001); those of stroke were 3.1% (95% CI, 1.1-5.0%), 5.3% (95% CI, 3.0-7.5%), and 6.1% (95% CI, 4.8-7.4%), respectively (P = 0.01); and those for ACS were 4.1% (95% CI, 2.1-6.1%), 6.6% (95% CI, 3.7-9.5%), and 7.4% (95% CI, 5.9-9.0%), respectively (P = 0.05). As compared with the untreated cohort, antiviral treatment was associated with multivariate-adjusted hazard ratios of 0.16 (95% CI, 0.07-0.33%) for ESRD, 0.53 (95% CI, 0.30-0.93) for ischemic stroke, and 0.64 (95% CI, 0.39-1.06) for ACS. Conclusion: Antiviral treatment for HCV infection is associated with improved renal and cardiovascular outcomes in diabetic patients.

Original languageEnglish
Pages (from-to)1293-1302
Number of pages10
JournalHepatology
Volume59
Issue number4
DOIs
Publication statusPublished - 2014 Apr

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Virus Diseases
Hepacivirus
Antiviral Agents
Confidence Intervals
Kidney
Therapeutics
Acute Coronary Syndrome
Stroke
Diabetes Mellitus
Propensity Score
Ribavirin
National Health Programs
Taiwan
Interferons
Insulin Resistance
Comorbidity
Cohort Studies
Databases

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Hsu, Yao Chun ; Lin, Jaw Town ; Ho, Hsiu J. ; Kao, Yu Hsi ; Huang, Yen Tsung ; Hsiao, Nai Wan ; Wu, Ming Shiang ; Liu, Yi Ya ; Wu, Chun Ying. / Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients. In: Hepatology. 2014 ; Vol. 59, No. 4. pp. 1293-1302.
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title = "Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients",
abstract = "Hepatitis C virus (HCV) infection is causally associated with insulin resistance and diabetes mellitus. This population-based cohort study aimed to investigate whether antiviral therapy for HCV infection was associated with improved clinical outcomes related to diabetes. From the Taiwan National Health Insurance Research Database, 2,267,270 Taiwanese residents diagnosed with diabetes mellitus were screened for eligibility. HCV infection was defined by a specific diagnosis code and measurement of serum antibody. After excluding patients with serious comorbidity, we enrolled a total of 1,411 eligible patients who received pegylated interferon plus ribavirin (treated cohort), and matched them 1:1 with 1,411 untreated controls by propensity scores (untreated cohort). We also matched the treated cohort 1:4 with 5,644 diabetic patients without HCV infection (uninfected cohort). Participants were followed up for the occurrence of endstage renal disease (ESRD), ischemic stroke, and acute coronary syndrome (ACS) after receiving antiviral treatment or the corresponding calendar date. From 2003 to 2011, the 8-year cumulative incidences of ESRD in the treated, untreated, and uninfected cohorts were 1.1{\%} (95{\%} confidence interval [CI], 0.3-2.0{\%}), 9.3{\%} (95{\%} CI, 5.9-12.7{\%}), and 3.3{\%} (95{\%} CI, 2.3-4.3{\%}), respectively (P < 0.001); those of stroke were 3.1{\%} (95{\%} CI, 1.1-5.0{\%}), 5.3{\%} (95{\%} CI, 3.0-7.5{\%}), and 6.1{\%} (95{\%} CI, 4.8-7.4{\%}), respectively (P = 0.01); and those for ACS were 4.1{\%} (95{\%} CI, 2.1-6.1{\%}), 6.6{\%} (95{\%} CI, 3.7-9.5{\%}), and 7.4{\%} (95{\%} CI, 5.9-9.0{\%}), respectively (P = 0.05). As compared with the untreated cohort, antiviral treatment was associated with multivariate-adjusted hazard ratios of 0.16 (95{\%} CI, 0.07-0.33{\%}) for ESRD, 0.53 (95{\%} CI, 0.30-0.93) for ischemic stroke, and 0.64 (95{\%} CI, 0.39-1.06) for ACS. Conclusion: Antiviral treatment for HCV infection is associated with improved renal and cardiovascular outcomes in diabetic patients.",
author = "Hsu, {Yao Chun} and Lin, {Jaw Town} and Ho, {Hsiu J.} and Kao, {Yu Hsi} and Huang, {Yen Tsung} and Hsiao, {Nai Wan} and Wu, {Ming Shiang} and Liu, {Yi Ya} and Wu, {Chun Ying}",
year = "2014",
month = "4",
doi = "10.1002/hep.26892",
language = "English",
volume = "59",
pages = "1293--1302",
journal = "Hepatology",
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Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients. / Hsu, Yao Chun; Lin, Jaw Town; Ho, Hsiu J.; Kao, Yu Hsi; Huang, Yen Tsung; Hsiao, Nai Wan; Wu, Ming Shiang; Liu, Yi Ya; Wu, Chun Ying.

In: Hepatology, Vol. 59, No. 4, 04.2014, p. 1293-1302.

Research output: Contribution to journalArticle

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T1 - Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients

AU - Hsu, Yao Chun

AU - Lin, Jaw Town

AU - Ho, Hsiu J.

AU - Kao, Yu Hsi

AU - Huang, Yen Tsung

AU - Hsiao, Nai Wan

AU - Wu, Ming Shiang

AU - Liu, Yi Ya

AU - Wu, Chun Ying

PY - 2014/4

Y1 - 2014/4

N2 - Hepatitis C virus (HCV) infection is causally associated with insulin resistance and diabetes mellitus. This population-based cohort study aimed to investigate whether antiviral therapy for HCV infection was associated with improved clinical outcomes related to diabetes. From the Taiwan National Health Insurance Research Database, 2,267,270 Taiwanese residents diagnosed with diabetes mellitus were screened for eligibility. HCV infection was defined by a specific diagnosis code and measurement of serum antibody. After excluding patients with serious comorbidity, we enrolled a total of 1,411 eligible patients who received pegylated interferon plus ribavirin (treated cohort), and matched them 1:1 with 1,411 untreated controls by propensity scores (untreated cohort). We also matched the treated cohort 1:4 with 5,644 diabetic patients without HCV infection (uninfected cohort). Participants were followed up for the occurrence of endstage renal disease (ESRD), ischemic stroke, and acute coronary syndrome (ACS) after receiving antiviral treatment or the corresponding calendar date. From 2003 to 2011, the 8-year cumulative incidences of ESRD in the treated, untreated, and uninfected cohorts were 1.1% (95% confidence interval [CI], 0.3-2.0%), 9.3% (95% CI, 5.9-12.7%), and 3.3% (95% CI, 2.3-4.3%), respectively (P < 0.001); those of stroke were 3.1% (95% CI, 1.1-5.0%), 5.3% (95% CI, 3.0-7.5%), and 6.1% (95% CI, 4.8-7.4%), respectively (P = 0.01); and those for ACS were 4.1% (95% CI, 2.1-6.1%), 6.6% (95% CI, 3.7-9.5%), and 7.4% (95% CI, 5.9-9.0%), respectively (P = 0.05). As compared with the untreated cohort, antiviral treatment was associated with multivariate-adjusted hazard ratios of 0.16 (95% CI, 0.07-0.33%) for ESRD, 0.53 (95% CI, 0.30-0.93) for ischemic stroke, and 0.64 (95% CI, 0.39-1.06) for ACS. Conclusion: Antiviral treatment for HCV infection is associated with improved renal and cardiovascular outcomes in diabetic patients.

AB - Hepatitis C virus (HCV) infection is causally associated with insulin resistance and diabetes mellitus. This population-based cohort study aimed to investigate whether antiviral therapy for HCV infection was associated with improved clinical outcomes related to diabetes. From the Taiwan National Health Insurance Research Database, 2,267,270 Taiwanese residents diagnosed with diabetes mellitus were screened for eligibility. HCV infection was defined by a specific diagnosis code and measurement of serum antibody. After excluding patients with serious comorbidity, we enrolled a total of 1,411 eligible patients who received pegylated interferon plus ribavirin (treated cohort), and matched them 1:1 with 1,411 untreated controls by propensity scores (untreated cohort). We also matched the treated cohort 1:4 with 5,644 diabetic patients without HCV infection (uninfected cohort). Participants were followed up for the occurrence of endstage renal disease (ESRD), ischemic stroke, and acute coronary syndrome (ACS) after receiving antiviral treatment or the corresponding calendar date. From 2003 to 2011, the 8-year cumulative incidences of ESRD in the treated, untreated, and uninfected cohorts were 1.1% (95% confidence interval [CI], 0.3-2.0%), 9.3% (95% CI, 5.9-12.7%), and 3.3% (95% CI, 2.3-4.3%), respectively (P < 0.001); those of stroke were 3.1% (95% CI, 1.1-5.0%), 5.3% (95% CI, 3.0-7.5%), and 6.1% (95% CI, 4.8-7.4%), respectively (P = 0.01); and those for ACS were 4.1% (95% CI, 2.1-6.1%), 6.6% (95% CI, 3.7-9.5%), and 7.4% (95% CI, 5.9-9.0%), respectively (P = 0.05). As compared with the untreated cohort, antiviral treatment was associated with multivariate-adjusted hazard ratios of 0.16 (95% CI, 0.07-0.33%) for ESRD, 0.53 (95% CI, 0.30-0.93) for ischemic stroke, and 0.64 (95% CI, 0.39-1.06) for ACS. Conclusion: Antiviral treatment for HCV infection is associated with improved renal and cardiovascular outcomes in diabetic patients.

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