Directly acting antivirals improve insulin resistance in nondiabetic patients with hepatitis C: a systematic review and meta-analysis

Abstract

Aims: Insulin resistance, beta-cell dysfunction, and diabetes mellitus (DM) are the extrahepatic complications of chronic hepatitis C virus (HCV) infection. The aim of the study was to determine the effects of novel directly acting antivirals (DAAs) on insulin resistance and insulin sensitivity parameters in nondiabetic patients with chronic HCV infection. Methods: A systematic search of medical databases (Pubmed, Scopus, and Google Scholar) was conducted for studies published until July 2024. Studies investigating the effect of any DAA on insulin resistance and insulin sensitivity parameters in nondiabetic patients with chronic HCV and sustained virologic response were included. Our study assessed the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) as the primary outcome. The pooled outcomes were compared pretreatment and posttreatment with DAAs using Hedges’ g (HG) with a 95% confidence interval (CI). Results: A total of 10 studies (1309 participants) were included in the meta-analysis. Insulin resistance measured by the HOMA-IR was significantly reduced with DAA therapy (HG = 0.86, 95% CI: 0.48–1.25, P < 0.001). A similar significant reduction in fasting insulin levels was observed following DAA therapy (HG = 0.88, 95% CI: 0.51–1.25, P < 0.001). However, no significant differences were seen in Homeostasis model assessment for beta-cell function (HOMA-B) (HG = 0.12, 95% CI: −0.0 to 0.24, P = 0.06) before and after DAAs use. Conclusions: The use of DAAs in nondiabetic chronic HCV patients with a sustained virologic response also significantly reduces insulin resistance and fasting insulin levels.