title: Insulin resistance is associated with liver stiffness in HIV/HCV co-infected patients.
abstract: BACKGROUND
  The factors that influence liver fibrosis progression in patients co-infected with human immunodeficiency virus/hepatitis C virus (HIV/HCV) are not completely understood. It is not known if insulin resistance (IR), a condition that promotes liver fibrosis in HCV mono-infected individuals, is one of these factors.
  
  
  OBJECTIVE
  To evaluate the association between IR and liver stiffness (LS).
  
  
  METHODS
  Multicentre cross-sectional study.
  
  
  METHODS
  330 patients co-infected with HIV/HCV.
  
  
  METHODS
  LS was assessed by transient elastography, which has shown a high accuracy to predict significant fibrosis in patients co-infected with HIV/HCV. The outcome variable of the study was LS. Patients with LS> or =9 kPa were considered as having significant fibrosis. IR was calculated using the HOMA method.
  
  
  RESULTS
  LS was > or =9 kPa in 150 (45%) patients. HOMA correlated with LS (Spearman's rho correlation coefficient, 0.37; p<0.0001). The median (Q1-Q3) HOMA in patients with LS> or =9 kPa was 3.30 (2.17-5.16) while it was 2.09 (1.37-3.22) in patients with LS <9 kPa (p<0.0001). Ninety-six (39%) individuals with a HOMA <4 and 54 (63%) with a HOMA > or =4 showed LS> or =9 kPa (p<0.0001). Analyses after excluding patients with cirrhosis yielded similar results. After multivariate analyses, age > or =40 years (adjusted odds ratio (AOR), 1.85; 95% confidence interval (CI), 1.03 to 3.29; p = 0.03), CD4 cell count <200 cells/ml (AOR, 3.45; 95% CI, 1.67 to 7.11; p = 0.001), hepatitis B virus co-infection (AOR, 9.25; 95% CI, 2.42 to 35.31; p = 0.001), and HOMA > or =4 (AOR, 5.33; 95% CI, 2.70 to 10.49; p<0.0001) were the independent predictors of LS> or =9 kPa.
  
  
  CONCLUSIONS
  IR is associated with LS in patients co-infected with HIV/HCV.
authors.affiliation: Unidad de Enfermedades Infecciosas. Hospital Universitario de Valme. Avenida de Bellavista, Sevilla, Spain. japineda@telefonica.net
authors.forename: N
authors.initials: N
authors.lastname: Merchante
authors.forename: A
authors.initials: A
authors.lastname: Rivero
authors.forename: I
authors.initials: I
authors.lastname: de Los Santos-Gil
authors.forename: D
authors.initials: D
authors.lastname: Merino
authors.forename: M
authors.initials: M
authors.lastname: Márquez
authors.forename: M A
authors.initials: MA
authors.lastname: López-Ruz
authors.forename: J
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: J
authors.initials: J
authors.lastname: Del Valle
authors.forename: A
authors.initials: A
authors.lastname: Camacho
authors.forename: J
authors.initials: J
authors.lastname: Sanz-Sanz
authors.forename: J
authors.initials: J
authors.lastname: Macías
authors.forename: I
authors.initials: I
authors.lastname: Pérez-Camacho
authors.forename: J
authors.initials: J
authors.lastname: Gómez-Mateos
authors.forename: A
authors.initials: A
authors.lastname: Moro
authors.forename: J A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000821:virology*; D008297:Male; D008875:Middle Aged