HbA1c is an important marker for glycemic control; however, not only plasma glucose levels but also RBCs' lifespan determines the value. Some of interferon-free, direct-acting antiviral regimens for hepatitis C are combined with ribavirin, which causes hemolytic anemia. Hemolytic anemia shortens the RBCs' lifespan and lowers HbA1c levels. We monitored HbA1c levels in 28 patients during and after antiviral therapy with daily sofosbuvir (400 mg) plus weight-based ribavirin for hepatitis C. Five cases (18%) had antidiabetic medication. The hemoglobin concentration, 13.9 ± 1.4 g/dl at the baseline, significantly fell to 12.0 ± 1.3 g/dl at the 4th week of treatment (P < 0.001). It hardly declined further during the treatment and immediately recovered after the end of treatment. Although there was no significant change in the random plasma glucose levels, the HbA1c level, 5.8% ± 0.7% at the baseline, gradually declined to 4.3% ± 0.7% (- 1.5% ± 0.7%, P < 0.001) at the end of treatment. It partly recovered to 4.8% ± 0.6% at the 4th week after treatment, then further increased to 6.2% ± 0.9% at the 12th week, and eventually returned to 5.7% ± 0.7%, which was similar to the value at baseline.

Conclusions: interferon-free, direct-acting antiviral regimen combined with ribavirin temporally causes artificial declines in HbA1c levels.


A. Moriya: None. Y. Iwasaki: None. M. Ando: None.

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