BACKGROUND: Hepatitis C virus (HCV) infection may induce insulin resistance (IR) irrespective of the severity of liver disease, and there is evidence of a central role for IR in failure to achieve sustained virological response (SVR) in HCV patients. OBJECTIVE: To assess IR as a predictor of the severity of hepatic fibrosis in Egyptian HCV patients, and its effect on early viral kinetics and virological response to HCV therapy. METHODS: A total of 140 chronic HCV patients were divided into two groups according to the homeostasis model assessment-IR (HOMA-IR). Group 1 consisted of 48 chronic HCV patients with HOMA-IR >=2, and group 2 consisted of 92 chronic HVC patients without IR (HOMA IR <2). All patients were treated with combination therapy (pegylated interferon-alpha 2a plus ribavirin) for 48 weeks and studied for viral kinetics throughout the period of therapy. RESULTS: The study revealed that older age, higher body mass index and HOMA-IR >=2 were significantly associated with advanced fibrosis. Rapid virological response, complete early virological response and SVR were significantly lower in the IR-HCV group compared with the non-IR-HCV group. Univariate and multivariate analyses revealed that older age, fibrosis (F>=3), high viral load (>600,000 IU⁄mL) and HOMA-IR >=2 were significantly associated with a lack of viral kinetics as well as SVR. However, HOMA-IR >=2 was the main independent variable associated with lack of SVR. On the other hand, body mass index, plasma insulin level and HOMA-IR decreased significantly compared with starting levels in patients who achieved SVR. This suggests a cause and effect relationship between HCV infection and IR. CONCLUSION: IR in chronic HCV patients is associated with progressive fibrosis and slow viral kinetics, and could be a predictor for lack of rapid and early virological response. Therefore, HOMA-IR levels should be measured and improved before starting antiviral treatment.
BACKGROUND:Hepatitis C virus (HCV) infection may induce insulin resistance (IR) irrespective of the severity of liver disease, and there is evidence of a central role for IR in failure to achieve sustained virological response (SVR) in HCVpatients. OBJECTIVE: To assess IR as a predictor of the severity of hepatic fibrosis in Egyptian HCVpatients, and its effect on early viral kinetics and virological response to HCV therapy. METHODS: A total of 140 chronic HCVpatients were divided into two groups according to the homeostasis model assessment-IR (HOMA-IR). Group 1 consisted of 48 chronic HCVpatients with HOMA-IR >=2, and group 2 consisted of 92 chronic HVC patients without IR (HOMA IR <2). All patients were treated with combination therapy (pegylated interferon-alpha 2a plus ribavirin) for 48 weeks and studied for viral kinetics throughout the period of therapy. RESULTS: The study revealed that older age, higher body mass index and HOMA-IR >=2 were significantly associated with advanced fibrosis. Rapid virological response, complete early virological response and SVR were significantly lower in the IR-HCV group compared with the non-IR-HCV group. Univariate and multivariate analyses revealed that older age, fibrosis (F>=3), high viral load (>600,000 IU⁄mL) and HOMA-IR >=2 were significantly associated with a lack of viral kinetics as well as SVR. However, HOMA-IR >=2 was the main independent variable associated with lack of SVR. On the other hand, body mass index, plasma insulin level and HOMA-IR decreased significantly compared with starting levels in patients who achieved SVR. This suggests a cause and effect relationship between HCV infection and IR. CONCLUSION: IR in chronic HCVpatients is associated with progressive fibrosis and slow viral kinetics, and could be a predictor for lack of rapid and early virological response. Therefore, HOMA-IR levels should be measured and improved before starting antiviral treatment.
Authors: Manuel Romero-Gómez; Maria Del Mar Viloria; Raúl J Andrade; Javier Salmerón; Moisés Diago; Conrado M Fernández-Rodríguez; Raquel Corpas; Marina Cruz; Lourdes Grande; Luis Vázquez; Paloma Muñoz-De-Rueda; Pilar López-Serrano; Ana Gila; María L Gutiérrez; Celia Pérez; Angela Ruiz-Extremera; Emilio Suárez; Jesús Castillo Journal: Gastroenterology Date: 2005-03 Impact factor: 22.682
Authors: Hari S Conjeevaram; David E Kleiner; Jay E Everhart; Jay H Hoofnagle; Steven Zacks; Nezam H Afdhal; Abdus S Wahed Journal: Hepatology Date: 2007-01 Impact factor: 17.425
Authors: Hossein Poustchi; Francesco Negro; Jason Hui; Ian Homer Y Cua; Laura Rubbia Brandt; James G Kench; Jacob George Journal: J Hepatol Date: 2007-10-01 Impact factor: 25.083
Authors: G Svegliati-Baroni; E Bugianesi; T Bouserhal; F Marini; F Ridolfi; F Tarsetti; F Ancarani; E Petrelli; E Peruzzi; M Lo Cascio; M Rizzetto; G Marchesini; A Benedetti Journal: Gut Date: 2007-03-28 Impact factor: 23.059