Discussion:
Within 1959 patients, this study illuminates the effect of cofounding
factors such as HTN, DM, BMI, age and gender in patients having HCV
virus infection. Illustrating each of these points depends on a
multivariate analysis for diverse parameters and patients risk factors
in positive HCV patients. After analyzing the results of the study,
infected female patients were found to be more with (1156) patients with
59 %, and male patients where 803 patients with 41 %. Infected
patients aged ≥ 40 year old were 85.6 % , Obese patients with BMI ≥ 30
( Kg/ m2) were 45.4 % and patients with uncontrolled blood pressure
with systolic blood pressure ≥ 130 mm.Hg were (43.7 %) and diastolic
blood pressure ≥ 80 mm.Hg were 72.1%.
In this study we found that in all patients with chronic HCV that the
age ≥ 40 , BMI ≥ 30 (Kg/ m2) and high systolic blood pressure with
esteem of ≥ 130 mm.Hg , are all independent factors for DM2. These
findings suggest that ageing , being corpulent and having a high
uncontrolled blood pressure all together with positive HCV infection
increases the rates of glucose abnormalities including anomalies in
carbohydrate metabolism, insulin resistance, metabolic clutters which
may progress into DM2 [14] .
Several studies had mentioned some explanations for this hypothesis
which is increasing risk of getting DM in HCV infected patients . In an
important study by Abdelaziz, S.B., et al, suggesting that diabetic
patients might get infected due to contaminated injections or nosocomial
transmission, but this hypothesis was reduced due to the widespread use
of universal precautions in hospitals. Other possible mechanisms include
that the progressive increase of liver fibrosis and cirrhosis as common
complications of being HCV positive patient [14] are inducing
glucose metabolism impairment or reduction in glucose uptake by the
cells [1] . Cirrhosis itself is
considered diabetogenic . On the other hand, diabetes can worsen
hepatitis C outcomes, including increasing the risk for cirrhosis and
hepatocellular carcinoma (HCC) [16]
[17] . .
Also, another study has suggested that eradication of HCV patients with
direct-acting antiviral (DAA) therapy leads to improved glycemic control
in patients with T2DM , decrease level of HbA1c and decrease the
proportion of patients taking insulin
[18] .
For other factors linking being diabetic and HCV positive patient, as
mentioned before females have higher rate than men in the current study
and another study [1] . Unlike other
studies which found that Hepatitis C is more common among men than women
, and male gender is also associated with more hepatitis C disease
progression to fibrosis and cirrhosis
[16] .
Occurrence and recurrence of HCC are high among patients with chronic
HCV infection, obesity, and heavy alcohol intake. Also, nonalcoholic
fatty liver disease (NAFLD) due to obesity by itself can increase the
inflammation of liver or cause other obesity-related diseases
[19].
[20]. Also in this current study ,
one of the interesting finding was the impact of BMI , as the
multivariate analysis in the study revealed that having BMI ≥ 30 (Kg
/m2) affects different parameters in HCV positive patients. The study
noticed that the incidence of getting HCV infection is highly increased
in those obese, aged ≥ 40 years, diabetic ≥ 200 mg/dL and with
uncontrolled blood pressure ( diastolic blood pressure ≥ 80 mm.Hg) .
In Ali-Eldin, Z.A., et al, study showed that free fatty acid and
cytokine secretion induced by adipose tissue dysfunction may contribute
in both liver steatosis and induction of inflammation and as a result
fibrosis level and the degree of hepatic affection in chronic HCV
patients. Furthermore, changes in glucose metabolism which results into
insulin resistance as mentioned before , all are associated with more
liver disease , so changes in the hosts lipid metabolism due to chronic
HCV increase viral replication, which can lead to steatosis and may
affect the efficacy of interferon-based therapy. This represents a novel
target for therapeutic intervention in HCV eradication
[21] .
Another vital factor in the multivariate analysis is that cardiovascular
diseases appear to be increased with higher rate of morbidity and
mortality especially hypertensive patients with blood pressure ≥ 130
mm.Hg ( with systolic blood pressure ≥ 130 mm.Hg and diastolic blood
pressure ≥ 80 mm.Hg) , and also BMI ≥ 30 ( kg/m2)
[22] . Unlike other studies which
depends only on hypertension and diabetes and showed two-fold higher
risk of subclinical carotid plaques among HCV-infected individuals
compared to uninfected controls and increase in the rate of peripheral
arterial diseases as well. This maybe due to the severity of the liver
damage or even due to direct viral activity
[23] .
In recent study untreated HCV infected persons have twice risk of CVD
(Cardiovascular diseases) as: (coronary artery disease events, acute
myocardial infarction, congestive heart failure, unstable angina, and
revascularization procedures, stroke and peripheral vascular disease)
than those who initiated treatment
[24]. As a result, significant
benefit of HCV treatment on the incidence and risk of possible CVD
events in the future [24]. Other
studies have mentioned that co-infection with both HCV/HIV viruses are
associated with more risk to CVD [25]
[26], so reduction in survival is
obvious in HIV/HCV- coinfected patients than HIV-monoinfected patients
and HIV-coinfected patients without cirrhosis
[27] . Concerning another study,
persistent HCV replication leads to a state of systemic inflammation and
immune activation that leads to endothelial dysfunction, atherosclerosis
and increased CVD risk [15] .