[Insulin resistance in chronic hepatitits C].
OBJECTIVE
To revise the importance of insulin resistance in the development of chronic hepatitis C and its interference in the response to the antiviral treatment of these patients.


METHODS
Bibliographic revision of published papers in the MEDLINE and the authors data.


RESULTS
In the last years several published papers have demonstrated an important relationship between insulin resistance and chronic hepatitis C. Increased prevalence of type 2 diabetes mellitus, the development of hepatic steatosis (specially in non-3 genotype), a more rapid progression of hepatic disease and reduction in the sustained virological response to treatment with pegylated interferon plus ribavirin have been associated with insulin resistance in patients infected with HCV. The mechanism implied in the insulin resistance is the enhanced production of tumor necrosis factor by the HCV core. Tumor necrosis factor affects insulin receptor substrate phosphorylation, resulting in decreased glucose uptake and compensatory hyperinsulinemia. Increased liver iron accumulation and modification in the levels of adipocytokinemia can have an additional effect on insulin sensitivity in chronic C hepatitis.


CONCLUSIONS
Diagnosing and treating insulin resistance in patients with chronic hepatitis C could not only avoid complications but also prevent disease progression and increased the sustained virological rate to treatment with pegylated interferon plus ribavarin.
Parise
Edison Roberto
ER
Universidade Federal de São Paulo, SP. parise@gastro.epm.br
Oliveira
Ana Cláudia de
AC
D000998:Antiviral Agents / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D005234:Fatty Liver / Q000150:complications* / Q000503:physiopathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007333:Insulin Resistance; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a