There has been a growing concern in patients affected by chronic Hepatitis virus infection because hepatitis not only affects the liver but can also have significant impacts on the overall health of the individuals, potentially leading to the development of several worse conditions, such as diabetes or HIV.
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Hepatitis and Diabetes: The Complex Relationship
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Hepatitis Influences Diabetes: Discussion 1
Studies have revealed a significant link between chronic hepatitis virus infection and the risk of developing diabetes.(1) The World Health Organization (WHO) has mentioned that 170 million individuals are infected chronically with hepatitis C virus (HCV) worldwide,(2) and 347 million people have diabetes mellitus. Despite the reduced prevalence of hepatitis C infection in the U.S., the burden of the disease continues to grow because the hepatitis C-related diseases.(3) A large number of studies have reported an increased risk for type 2 diabetes in patients with hepatitis C virus infection.(4)
Hepatitis is associated with an increased risk of developing diabetes because the hepatitis virus impacts the liver, which is involved in storing glucose. When the liver does not function appropriately, it can result in high blood glucose levels and insulin resistance, thus increasing the likelihood of developing diabetes. In addition to this, patients with diabetes face a greater risk of contracting hepatitis B or hepatitis C, which, in turn, can result in more severe outcomes of their hepatitis infection.
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Hepatitis Does Not Influence Diabetes: Discussion 2
Some research has shown there was an increase in rates of diabetes among individuals with hepatitis C virus infection. However, some studies have shown no association between hepatitis C status and diabetes. These few studies could not confirm this association in the absence of liver dysfunction.(5)
Apart from this, the link between hepatitis B virus infection and diabetes has remained controversial. In certain studies, the prevalence of diabetes was higher in HBsAg (+ve) when compared with HBsAg (-ve)(6, 7, 8), but not in others.(9, 10)
NOTE: [HBsAg (+ve) and HBsAg (-ve) refer to positive and negative surface antigen statuses].
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Hepatitis and Diabetes: Drawing an Inference From the Studies
Although there are studies that show there hepatitis and diabetes are linked with each other, there are also a few studies that confirm no association between the two conditions. However, the majority of studies strongly support the association between hepatitis and diabetes.
While insulin resistance and type 2 diabetes are more frequently reported as complications of hepatitis C virus infection, the infection is also known to be linked with multiple autoimmune manifestations, such as type 1 diabetes.(11, 12) In addition to this, therapy used for chronic hepatitis C virus infection, especially interferon alpha (IFNα), can also trigger diabetes.
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Preventing or Managing Hepatitis and Diabetes
Managing both hepatitis and diabetes needs a comprehensive approach. From blood sugar management to essential vaccinations and infection control, and from dietary modification to taking proper healthcare, everything is essential. Someone facing both these challenges should go for regular check-ups, have proper medication management, and lifestyle modifications. One should also try to lose weight by exercising and healthy eating. All these would help in maintaining overall health.
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Hepatitis and HIV
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A Brief Note
Hepatitis C (HCV) and hepatitis B virus (HBV) infections are commonly seen among HIV patients. This is because HCV and HBV infections and human immunodeficiency virus (HIV) infection have shared routes of viral transmission. In recent times, liver disease due to chronic hepatitis B virus and hepatitis C virus infection has turned out to be a leading cause of death among people with HIV infections globally.(13) So, despite being two separate viral diseases, hepatitis and HIV have a strong connection due to their common mode of transmission.
Hepatitis A and HIV
Since 2016, widespread hepatitis A outbreaks associated with person-to-person transmission have been occurring. Patients with HIV who have underlying liver disease are at risk of developing severe disease from an infection of the hepatitis A virus.(14) So, it is recommended by the CDC and ACIP that such a population should take hepatitis A vaccination positively.
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Hepatitis B and HIV
Hepatitis B virus (HBV) and human immunodeficiency virus (HIV), both are bloodborne viruses, primarily transmitted through sexual contact and also the use of injection-drug. Since both these infections are caused due to shared modes of transmission, a high proportion of adults who are at risk of HIV infection are also at risk of developing hepatitis B infection. Patients with human immunodeficiency virus who become infected with hepatitis B virus are at severe risk for liver-related morbidity and mortality.(15, 16, 17, 18)
To prevent hepatitis B infection, the Advisory Committee on Immunization Practices (ACIP) recommends universal hepatitis B vaccination for all susceptible patients being infected with HIV.(19) HIV patients who test positive for hepatitis B virus (HBV) infection, should receive HIV antiviral medication with activity against HBV, such as Tenofovir and Entecavir.
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Hepatitis C and HIV
In 2009, approximately 21% of adults with human immunodeficiency virus (HIV) who were tested for past or present HCV infection tested positive. However, the prevalence of confection varies substantially according to risk group (for instance, men who had sex with men (MSM), people who were exposed to injected drugs, and high-risk heterosexuals.(20, 21, 22)
Hepatitis C Virus (HCV) infection can also affect the management of HIV infection. CDC has recommended a one-time hepatitis C testing for all adults, including those with HIV.(23)
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Preventing Hepatitis and HIV
Patients with HIV or AIDS must be vaccinated against hepatitis A and B and also tested for hepatitis B (HBV) and hepatitis C virus (HCV)
However, in 2020, the CDC and ACIP started recommending that everyone with HIV, who are less than one year of age should be vaccinated against hepatitis A and receive postvaccination serologic testing less than one month after completing the series of hepatitis A vaccine.(24)
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Hepatitis, Diabetes, and HIV: A Dangerous Trio
Due to frequent percutaneous exposure to blood, patients with diabetes face an increasing risk of hepatitis B. Additionally, co-infection with both HIV and viral hepatitis can have significant effects on infected persons. Liver disease, usually associated with hepatitis B or hepatitis C, is a leading cause of developing non-AIDS-related mortalities among patients with HIV.(25)
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Final Words
It is important to understand the connections between hepatitis and other chronic conditions, such as HIV and diabetes. This would help develop comprehensive healthcare management. The impact of hepatitis on the liver and its potential ramifications on glucose metabolism can affect the patient’s overall health. Thus, people with diabetes must be vigilant about the prevention of hepatitis and vice versa. Similarly, patients with HIV should also be mindful of potential co-infection with the hepatitis virus. Thus, being more aware of these conditions and regularly consulting and following up with doctor’s prescribed treatments could help in living an overall healthy life. Apart from being more aware of the conditions, taking all necessary preventive measures, and frequent medical consultation is highly essential for individuals affected by these chronic conditions.
- Negro F, Alaei M. Hepatitis C virus and type 2 diabetes. World J Gastroenterol. 2009 Apr 7;15(13):1537-47. doi: 10.3748/wjg.15.1537. PMID: 19340895; PMCID: PMC2669937. LINK: Hepatitis C virus and type 2 diabetes – PMC (nih.gov)
- Hepatitis C. World Health Organisation Media Center (2013). Available from: http://www.who.int/mediacentre/factsheets/fs164/en/ Google Scholar
- Razavi H, Elkhoury AC, Elbasha E, Estes C, Pasini K, Poynard T, et al. Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology(2013) 57(6):2164–70. doi: 10.1002/hep.26218 PubMed Abstract | CrossRef Full Text | Google Scholar
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- Lao, T. T., Tse, K. Y., Chan, L. Y., Tam, K. F. & Ho, L. F. HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women. Diabetes Care26, 3011–3016 (2003). Article PubMed Google Scholar
- Papatheodoridis, G. V. et al. Diabetes mellitus in chronic hepatitis B and C: prevalence and potential association with the extent of liver fibrosis. J Viral Hepat13, 303–310, doi:10.1111/j.1365-2893.2005.00677.x(2006). Article CAS PubMed Google Scholar
- Antonelli, A. et al. Hepatitis C virus infection: evidence for an association with type 2 diabetes. Diabetes Care28, 2548–2550 (2005). Article PubMed Google Scholar
- Wang, C. S., Wang, S. T., Yao, W. J., Chang, T. T. & Chou, P. Community-based study of hepatitis C virus infection and type 2 diabetes: an association affected by age and hepatitis severity status. Am J Epidemiol158, 1154–1160 (2003). Article PubMed Google Scholar
- Mehta, S. H. et al. Hepatitis C virus infection and incident type 2 diabetes. Hepatology38, 50–56, doi:10.1053/jhep.2003.50291(2003). Article PubMed Google Scholar
- Zein, C. O., Levy, C., Basu, A. & Zein, N. N. Chronic hepatitis C and type II diabetes mellitus: a prospective cross-sectional study. Am J Gastroenterol100, 48–55, doi:10.1111/j.1572-0241.2005.40429.x(2005). Article PubMed Google Scholar
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- Gatanaga H, Yasuoka A, Kikuchi Y, et al. Influence of prior HIV-1 infection on the development of chronic hepatitis B infection. Eur J Clin Microbiol Infect Dis. 2000 Mar;19(3):237-9.
- Thio CL, Seaberg EC, Skolasky R, et al. Multicenter AIDS Cohort Study. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002 Dec;360(9349):1921-6.
- Bonacini M, Louie S, Bzowej N, et al. Survival in patients with HIV infection and viral hepatitis B or C: a cohort study. AIDS. 2004 Oct 21;18(15):2039-45.
- Weber R, Sabin CA, Friis-Møller N, et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006 Aug 14-28;166(15):1632-41.
- Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2018;67(1):1-31.
- Garg S, Brooks J, Luo Q, Skarbinski J. Prevalence of and Factors Associated with Hepatitis C Virus (HCV) Testing and Infection Among HIV-infected Adults Receiving Medical Care in the United States. Infectious Disease Society of America (IDSA). Philadelphia, PA, 2014.
- Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, Berry SA, et al. Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts. PLoS ONE 2014;9(7):e102766. https://doi.org/10.1371/journal.pone.0102766external icon.
- Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis C virus infection among patients in the HIV Outpatient Study, 1996–2007. J Acquir Immune Defic Syndr 2010;53:388–396.
- Updated CDC Recommendations for Universal Hepatitis C Virus Screening Among Adults and Pregnant Women: Implications for Clinical Practice MMWR Article PDF
- Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5):1–38. DOI: http://dx.doi.org/10.15585/mmwr.rr6905a1external icon.
- How does Hepatitis Influences Diabetes and HIV? | NewsTrack English 1 (newstracklive.com)
Also Read:
- Hepatitis A: Signs, Symptoms, Diagnosis, Prevention, Treatment, Prognosis
- Viral Hepatitis: A, B, C, Definition, Causes, Symptoms, Phases of Clinical Manifestations, Diagnosis, Treatment
- What is Hepatitis C, How Does it Spread and Ways to Prevent Liver Damage in Hepatitis C
- How Hepatitis is Cured or Treated?
- How Hepatitis C Affects Different Systems of Your Body?
- Is It Possible To Cure Hepatitis C?
- Is Hepatitis E Sexually Transmitted?
