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To the Editor: In his Contempo Updates article about chronic hepatitis C virus (HCV), Dr Flamm¹ did not discuss the association between HCV infection and diabetes. For instance, Mason et al² reported that HCV infection was associated with diabetes. They also found that HCV genotype 2a was observed in 29% of patients with HCV-RNA–positive diabetes vs 3% of controls with local HCV infections. Similarly, Bigam et al³ found that among liver transplant recipients, pretransplant prevalence of diabetes was higher in the HCV group (29%) compared with the hepatitis B (6%) group. The prevalence of diabetes remained higher in the HCV group 1 year after transplantation. Moreover, Flamm did not mention that smoking is independently associated with elevated alanine aminotransferase levels in HCV-seropositive individuals. Patients who are seropositive for anti-HCV are strongly advised not to smoke.⁴

Ajit Singh Kashyap, MD; Kuldeep Parkash Anand, MD
Department of Medicine

Surekha Kashyap, MD
Department of Hospital Administration
Armed Forces Medical College
Pune, India

1. Flamm SL. Chronic hepatitis C virus infection. JAMA. 2003;289:2413-2417. FREE FULL TEXT 2. Mason AL, Lau JY, Hoang N, et al. Association of diabetes mellitus and chronic hepatitis C virus infection. Hepatology. 1999;29:328-333. FULL TEXT | WEB OF SCIENCE 3. Bigam DL, Pennington JJ, Carpentier A, et al. Hepatitis C-related cirrhosis: a predictor of diabetes after liver transplantation. Hepatology. 2000;32:87-90. FULL TEXT | WEB OF SCIENCE 4. Wang CS, Wang ST, Chang TT, et al. Smoking and alanine aminotransferase levels in hepatitis C virus infection: implications for prevention of hepatitis C virus progression. Arch Intern Med. 2002;162:811-815. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:1452.

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