La cura dell’Epatite C riduce diabete e ansia

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Una persona infetta da Epatite C ha il 31% in più di probabilità rispetto a una persona sana di andare incontro a malattie come diabete, insufficienza renale, disturbi dell’umore e quindi dell’ansia. Certamente una quota di queste ultime manifestazione sarà pure reattiva al problema principale ma tutto queste non impedisce che, in alcuni casi, possano addirittura diventare preponderanti. Per arrivare a queste conclusioni, alcuni ricercatori della British Columbia Center for Disease Control di Vancouver, British Columbia, hanno utilizzato i dati della coorte di test dell’epatite della Columbia Britannica, che includeva 1,3 milioni di individui sottoposti a screening per l’HCV. Tra questi sono stati identificati 10.264 individui con infezione da HCV che sono stati trattati con terapie a base di interferone tra il 1999 e 2014. Di tutti questi, 6.023 (59%) hanno raggiunto l’SVR, cioè una risposta virologica sostenuta ovvero la negatività dell’HCV-RNA a 12 settimane dalla conclusione del trattamento. Dall’analisi dei dati si è evinto inoltre che, nel gruppo dei soggetti che si era negativizzato e che quindi era riuscito a ottenere una risposta virologica sostenuta raggiunta a seguito del trattamento dell’epatite C, esisteva un rischio ridotto di diverse manifestazioni extra-epatiche, tra cui diabete di tipo 2, malattie renali croniche e disturbi dell’umore e ansia.

La ricerca, di cui riportiamo di seguito l’abstract, è stata pubblicata sulla rivista scientifica Journal of Hepatology.

ABSTRACT

Sustained Virologic Response from Interferon-based Hepatitis C regimes IS associated with Reduced risk of Extrahepatic Manifestations.

Rossi C, Jeong D, Wong S, McKee G, Ahmed Butt Z, Buxton J, Wong J, Darvishian M, Bartlett S, Samji H, Yu A, Binka M, Alvarez M, Adu PA, Tyndall M, Krajden M, Zafar Janjua N; BC Hepatitis Testers Cohort Team.

BACKGROUND & AIMS

Hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations (EHMs). We evaluated the impact of sustained virologic response (SVR) on the risk of seven EHMs contributing to the burden of extrahepatic disease: type II diabetes mellitus (T2DM), chronic kidney disease (CKD) or end-stage renal disease (ESRD), stroke, ischemic heart disease (IHD), major adverse cardiac events (MACE), mood and anxiety disorders, and rheumatoid arthritis (RA).

METHODS

A longitudinal cohort study was conducted using data from the British Columbia Hepatitis Testers Cohort, which included ∼1.3 million individuals screened for HCV. We identified all HCV-infected individuals who were treated with interferon-based therapies between 1999/04/01 and 2014/07/01. SVR was defined as a negative HCV RNA test ≥ 24 weeks post-treatment or after end-of-treatment, if unavailable. We computed adjusted subdistribution hazard ratios (asHR) for the effect of SVR on each EHM using competing risk proportional hazard models. Subgroup analysis by birth cohort, sex, injection drug exposure and genotype was also performed.

RESULTS

Overall, 10,264 HCV-infected individuals were treated with interferon, of whom 6,023 (59%) achieved SVR. As compared to those that failed treatment, EHM risk was significantly reduced among SVR patients for T2DM (asHR, 0.65; 95% confidence interval [CI], 0.55-0.77), CKD or ESRD (asHR, 0.53; 95%CI, 0.43-0.65), ischemic or hemorrhagic stroke (asHR, 0.73; 95%CI, 0.49-1.09), and mood and anxiety disorders (asHR, 0.82; 95%CI, 0.71-0.95), but not for IHD (asHR, 1.23; 95%CI, 1.03-1.47), MACE (asHR: 0.93; 95%CI: 0.79-1.11) or RA (asHR, 1.09; 95% CI, 0.73-1.64).

CONCLUSIONS

SVR was associated with a reduction in the risk of several EHMs. Increased uptake of antiviral therapy may reduce the growing burden of EHMs in this population.

LAY SUMMARY

We estimated rates of chronic comorbidities other than liver disease between those who were cured and those failed HCV treatment. Our findings showed that rates of these non-liver disease were largely reduced for those who were cured with interferon-based HCV treatments. Early HCV treatments could provide many benefits in prevention of various HCV complications beyond liver disease.