Unusual clinical course, Unusual or unexpected effect of treatment, Unexpected drug reaction
Mary-Anne Doyle, Curtis Cooper
Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, ON, Canada
Am J Case Rep 2015; 16:745-750
Type 2 diabetes is a well described extra-hepatic manifestation of hepatitis C infection (HCV). Eradication of HCV has led to improvements in insulin resistance but to date has not been shown to induce remission of diabetes.
CASE REPORT: We report a case of a 49-year-old man with HCV and a 2-year history of T2DM on oral agents. He was initially treated with peg-interferon/ribavirin (peg-IFN/rib) but did not achieve a HCV treatment response. Four years later he was retreated with peg-IFN/rib plus an HCV protease inhibitor (boceprevir). His HbA1c at the start of treatment was 7.9%. Antiviral response to HCV-therapy correlated with a significant improvement in glucose control without a change in diabetes therapy or improvement in adherence. He achieved a sustained virological response and within a year of completing antiviral therapy he no longer required medical therapy for diabetes. Two years after the completion of HCV treatment, the patient has maintained an HbA1c of 5.8% without any diabetes medications.
CONCLUSIONS: This case provides evidence of the important relationship between HCV and diabetes and highlights the potential reversibility of glucose abnormalities with successful eradication of HCV. Increased awareness of this association may improve detection of undiagnosed HCV infection, identify patients with reversible causes of diabetes, guide therapeutic decisions for HCV treatment, and improve outcomes in patients with both diseases.
Keywords: Diabetes Mellitus, Type 2 - complications, Antiviral Agents - therapeutic use, Hepatitis C, Chronic - drug therapy, Humans, Male, Middle Aged, Remission Induction - methods, Ribavirin - therapeutic use