Management of Hepatitis B and C Infection in Patients with Diabetes Mellitus

Abstract

Diabetes mellitus (DM) bidirectional interaction well known with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. DM may increase exposure risks regarding transmission due to factors such as healthcare contact, assisted blood glucose monitoring, and improper device/pen use during insulin administration; conversely, it can negatively impact the natural history of chronic liver disease via insulin resistance, hepatic steatosis, and systemic inflammation pathways. The 2023 Turkey Viral Hepatitis B and C Diagnosis and Treatment Guideline, along with international guidelines, recommend direct-acting antiviral (DAA) therapy for all HCV RNA-positive patients; for HBV, viral suppression using high-barrier nucleos(t)ide analogs is recommended based on the clinical phase, HBV DNA levels, ALT, and the degree of fibrosis. In patients with DM, the risk of hypoglycemia following the improvement of glycemic control after HCV treatment and HBV reactivation during DAA therapy are of particular clinical significance. This section presents screening-serology interpretation, verification-staging, treatment selection, infection control measures, follow-up, and HCC screening in accordance with Turkish clinical practice, accompanied by tables and algorithms.

Keywords

• diabetes mellitus
• hepatitis B
• hepatitis C
• vaccine

Diyabet Mellitus Hastalarında Hepatit B ve C Enfeksiyonunun Yönetimi

Abstract

Diyabetes mellitus (DM), kronik hepatit B virüsü (HBV) ve hepatit C virüsü (HCV) enfeksiyonlarıyla çift yönlü etkileşime sahip olduğu iyi bilinmektedir. DM; sağlık hizmeti teması, yardımcı kan şekeri ölçümü ve insülin uygulamalarında uygunsuz cihaz/kalem kullanımı gibi nedenlerle bulaş açısından maruziyeti artırabilir; diğer yandan insülin direnci, hepatik steatoz ve sistemik inflamasyon yolaklarıyla kronik karaciğer hastalığının doğal seyrini olumsuz etkileyebilir. Türkiye Viral Hepatit B ve C Tanı ve Tedavi Kılavuzu 2023 ve uluslararası rehberler, HCV RNA pozitif tüm hastalarda doğrudan etkili antiviral (DEA) tedaviyi; HBV’de ise klinik faz, HBV DNA düzeyi, ALT ve fibroz derecesine göre yüksek bariyerli nükleoz(t)id analogları ile viral baskılanmayı önermektedir. DM’li hastalarda HCV tedavisi sonrası glisemik kontrolün iyileşmesine bağlı hipoglisemi riski ve DEA tedavisi sırasında HBV reaktivasyonu, klinik olarak özellikle önem taşır. Bu bölümde Türkiye pratiğine uygun tarama-seroloji yorumlama, doğrulama-evreleme, tedavi seçimi, enfeksiyon kontrol önlemleri, izlem ve HCC taraması; tablolar ve algoritmalar eşliğinde sunulmuştur.

Keywords

• diyabetes mellitus
• hepatit B
• hepatit C
• aşı

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