High Prevalence of Hepatitis C Virus Infection in Diabetic Patients

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High Prevalence of Hepatitis C Virus Infection in Diabetic Patients

OBJECTIVE. To evaluate the prevalence of hepatitis C virus (HCV)

infection

in diabetic patients and to investigate the influence of several

epidemiological and clinical factors on HCV infection.

RESEARCH DESIGN AND METHODS. A total of 176 consecutive diabetic

patients

were compared with 6,172 blood donors, matched by recognized risk

factors to

acquire HCV infection. Serologic testing for anti-HCV was done using a

second-generation commercial enzyme-linked immunosorbent assay (ELISA),

and

an immunoblot assay was performed in anti-HCV positive samples to

confirm

HCV specificity. Diabetic patients were divided in two groups according

to

their HCV antibody status and analyzed for the following variables:

age,

sex, type of diabetes, duration of disease, mode of therapy, late

diabetic

complications, previous blood transfusions, intravenous drug addiction,

hospital admissions, major surgical procedures, and liver function

tests

(LFTs).

RESULTS. A higher prevalence of HCV infection was observed in diabetic

patients in comparison with blood donors (11.5 vs. 2.5%; P < 0.001;

odds

ratio 4.39; 95% CI 2.61-7.24). We did not detect any particular

epidemiological factor for HCV infection in anti-HCV positive diabetic

patients. In these patients, abnormal LFTs were observed in 72.3%,

compared

with only 24.7% of anti-HCV negative diabetic patients (P < 0.001).

CONCLUSIONS. A high prevalence of HCV infection was detected in

diabetic

patients, and most of anti-HCV positive patients presented with

abnormal

LFTs. Therefore, testing for HCV infection of diabetic patients with an

abnormal LFT is mandatory. The lack of any particular epidemiological

factor

for HCV infection in our diabetic population suggests that HCV may have

a

direct role in the development of diabetes.

Diabetes Care; 19, (9), September 1996:October 25, 1996

Disease Associations (HCV)

Hepatitis C May Be a Cause of Diabetes

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Hepatitis Weekly via Individual Inc. :

Hepatitis C virus may have a direct role in the development of

diabetes,

according to a report from Spain. Researcher Simo and colleagues

found a high prevalence of hepatitis C virus (HCV) infection in

patients

with diabetes, and found that most HCV patients presented with abnormal

liver function tests. " Testing for HCV infection of diabetic patients

with

an abnormal liver function test is mandatory, " Simo et al. wrote ( " High

Prevalence of HCV Infection in Diabetic Patients, " Diabetes Care,

September

1996;19(9):998- 1001). " The lack of any particular epidemiological

factor

for HCV infection in our diabetic population suggests that HCV may have

a

direct role in the development of diabetes. " Mild asymptomatic

elevations of

serum aminotransferases in a diabetic patient do not receive much

attention

because they are often attributed to fatty infiltration. It has been

hypothesized that, during the course of the disease, diabetic patients

are

more prone to acquire an HCV infection because they are subjected to

more

frequent medical interventions. While a link between diabetes and HCV

has

recently been suggested, a controlled study of prevalence and risk

factors

for HCV infection has not yet been performed. " The aim of this study

was to

evaluate the prevalence of HCV infection in diabetic patients attending

our

outpatient clinic in comparison with blood donors who were matched for

the

main risk factors associated with anti-HCV seropositivity, " Simo et al.

wrote. " Furthermore, we investigated the influence of several

epidemiological and clinical factors on HCV infection in diabetic

patients,

including type of diabetes, duration of the disease, mode of therapy,

and

presence of late complications. " A total of 176 consecutive diabetic

patients were compared with 6172 blood donors, matched by recognized

risk

factors to acquire HCV infection. Serologic testing for anti-HCV was

done

using a second-generation commercial enzyme-linked immunosorbent assay

(ELISA), and an immunoblot assay was performed in anti-HCV positive

samples

to confirm HCV specificity. Diabetic patients were divided into two

groups

according to their HCV antibody status and analyzed for age, sex, type

of

diabetes, duration of disease, mode of therapy, late diabetic

complications,

previous blood transfusion, intravenous drug addiction, hospital

admissions,

major surgical procedures, and liver function tests. Anti-HCV was

detected

in 18 diabetic patients and 156 blood donors (11.5 versus 2.5 percent;

P <

0.001). The estimated risk for HCV infection in diabetic patients was

4.39

times higher (95 percent CI 2.61-7.24) than in the control group. In

addition, Simo et al. did not observe a significant difference for

previous

blood transfusion (21.8 versus 16.7 percent) and intravenous drug

addiction

(10.2 versus 5.5 percent) between blood donors and diabetic patients

with

HCV infection, respectively. Only age (63.8 +/- 10.2 versus 49.4 +/-

17.8

years) and previous blood transfusion (16.7 versus 1.2 percent; P <

0.05)

were statistically related to HCV infection. After excluding the three

anti-HCV positive diabetic patients with previous blood transfusion,

the

global prevalence of anti-HCV seropositivity in the diabetic population

(15

of 175, or 8 percent) remained significant in comparison with the

control

group (P < 0.001; odds ratio 3.59; 95 percent CI 2.04-6.23).

Furthermore,

the three anti-HCV positive diabetic patients with previous blood

transfusion were transfused for unrelated diseases seven, 15, and 23

years

before diagnosis of diabetes. In anti-HCV positive diabetic patients,

abnormal liver function tests were seen in 72.3 percent, compared with

only

24.7 percent of anti-HCV negative diabetic patients (P < 0.001).

" Diabetic

patients have a high prevalence of abnormal liver function tests that

are

often attributed to fatty infiltration without further investigation, "

Simo

et al. wrote. " In this study, we have demonstrated for the first time

that

diabetic patients present a higher prevalence of HCV infection than

control

subjects who are matched for the main risk factors, such as age,

previous

blood transfusion, and intravenous drug addition. In addition, most of

anti-HCV positive patients presented with an abnormal liver function

test,

being a combination pattern of cytolysis and cholestasis as the

predominant

biochemical alteration. We feel that this is an important point, since

none

of these patients had been previously diagnosed with liver disease, and

diabetes was the only reason for referral to our unit. In consequence,

based

on our results, testing for HCV infection in diabetic patients with an

abnormal liver function test is mandatory. " The authors suggest their

results could be interpreted to mean either that diabetic patients have

some

undiscovered epidemiological factor that increases the risk of

acquiring HCV

infection or that HCV infection may have some etiopathogenic role in

the

development of diabetes. In recent studies et al. reported a

significantly increased rate of diabetes in patients with HCV related

cirrhosis, compared with other causes, and suggested that HCV infection

has

some etiopathogenic role in the development of diabetes (J Hepatol

1994;21:1135-1139). " Several possible mechanisms can be postulated to

link

HCV to diabetes, " Simo et al. wrote. " It may be possible that HCV,

similar

to the hepatitis B virus, could infect pancreatic islet cells and

thereby

induce damage to (alpha)-cells. On the other hand, HCV has been related

to

diseases in which the autoimmune phenomena play an important role, such

as

cyroglobulinemia, glomerulonephritis, thyroiditis, and Sjogren disease.

Therefore, an autoimmune destruction of endocrine pancreatic tissue

related

to HCV antigens or immunocomplexes cannot be excluded. "

The corresponding author for this study is Simo, Department of

Endocrinology, Hospital General Universitari Vall d'Hebron, Pg. Vall

d'Hebron 119-129, 08035 Barcelona, Spain.

Sim, MD, PHD; Cristina , MD; Joan Genesc, MD, PHD;

Rossend

Jard, MD, PHD; Jordi Mesa, MD, PHD

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