BACKGROUND: The aim of this study was to assess the effect of insulin resistance (IR) on the response to hepatitis C virus (HCV) therapy in HIV-HCV-coinfected patients. METHODS: A total of 238 HIV-HCV-coinfected patients (74% male, mean +/-sd age 40 +/-5 years, mean alcohol intake <50 g/day and 38% HCV genotype 2 or 3), treated by standard or pegylated interferon-alpha2b plus ribavirin during 48 weeks were studied. Liver biopsies were assessed before treatment. Patients were considered to have IR when the homeostasis model assessment of IR (HOMA-IR) was >2.5. Multiple logistic regression with stepwise selection was used to estimate independent factors associated with sustained virological response (SVR). RESULTS: IR was present in 32% and significant liver fibrosis (Metavir>or=F2) in 74% of patients. Patients with SVR (96/238 [40%]) were more likely to be infected with HCV genotype 2 or 3 (54% versus 27%; P<0.0001), and had more severe liver fibrosis (>or=F3; 45% versus 30%; P=0.03). By multivariate analysis, a HOMA-IR>2.5 had a negative effect on the SVR (odds ratio 0.49 [95% confidence interval 0.26-0.92]; P=0.05). CONCLUSIONS: A high HOMA-IR level is frequently found in HIV-HCV-coinfected patients and is associated with a reduced SVR rate. Improving insulin sensitivity might be a useful adjunct to HCV therapy in HIV-HCV-coinfected patients.
BACKGROUND: The aim of this study was to assess the effect of insulin resistance (IR) on the response to hepatitis C virus (HCV) therapy in HIV-HCV-coinfectedpatients. METHODS: A total of 238 HIV-HCV-coinfectedpatients (74% male, mean +/-sd age 40 +/-5 years, mean alcohol intake <50 g/day and 38% HCV genotype 2 or 3), treated by standard or pegylated interferon-alpha2b plus ribavirin during 48 weeks were studied. Liver biopsies were assessed before treatment. Patients were considered to have IR when the homeostasis model assessment of IR (HOMA-IR) was >2.5. Multiple logistic regression with stepwise selection was used to estimate independent factors associated with sustained virological response (SVR). RESULTS: IR was present in 32% and significant liver fibrosis (Metavir>or=F2) in 74% of patients. Patients with SVR (96/238 [40%]) were more likely to be infected with HCV genotype 2 or 3 (54% versus 27%; P<0.0001), and had more severe liver fibrosis (>or=F3; 45% versus 30%; P=0.03). By multivariate analysis, a HOMA-IR>2.5 had a negative effect on the SVR (odds ratio 0.49 [95% confidence interval 0.26-0.92]; P=0.05). CONCLUSIONS: A high HOMA-IR level is frequently found in HIV-HCV-coinfectedpatients and is associated with a reduced SVR rate. Improving insulin sensitivity might be a useful adjunct to HCV therapy in HIV-HCV-coinfectedpatients.
Authors: Marie-Louise C Vachon; Stephanie H Factor; Andrea D Branch; Maria-Isabel Fiel; Maribel Rodriguez-Torres; Norbert Bräu; Richard K Sterling; Jihad Slim; Andrew H Talal; Douglas T Dieterich; Mark S Sulkowski Journal: J Hepatol Date: 2010-08-21 Impact factor: 25.083
Authors: Adeel A Butt; Triin Umbleja; Janet W Andersen; Kenneth E Sherman; Raymond T Chung Journal: Clin Infect Dis Date: 2012-05-04 Impact factor: 9.079