Time course of insulin resistance during antiviral therapy in non-diabetic, non-cirrhotic patients with genotype 1 HCV infection.
BACKGROUND
Genotype 1 (G1) hepatitis C virus (HCV) is associated with insulin resistance (IR) and its clearance seems to improve insulin sensitivity. We aimed to evaluate the time course of IR in response to antiviral therapy in non-diabetic, non-cirrhotic G1 HCV patients and to assess the effect of metabolic factors on sustained virological response (SVR).


METHODS
A total of 83 consecutive treatment-naive G1 chronic hepatitis C (CHC) patients were evaluated by anthropometric and metabolic measurements, including IR using the homeostasis model assessment (HOMA). Patients were considered to have IR if HOMA was >2.7. All cases had a liver biopsy scored for staging, grading and steatosis. Anthropometric parameters and HOMA were re-evaluated at the end of antiviral therapy and at follow-up.


RESULTS
SVR was achieved in 46 (55.4%) patients. By logistic regression, female gender (odds ratio [OR] 0.132, 95% confidence interval [CI] 0.33-0.529), gamma-glutamyltransferase >50 IU (OR 0.217, 95% CI 0.066-0.720) and presence of steatosis (OR 0.134, 95% CI 0.028-0.654) were independent negative predictors of SVR, whereas low-density lipoprotein cholesterol >107 IU (OR 6.671, 95% CI 1.164-11.577) was a positive predictor of SVR. The proportion of patients with IR significantly decreased (P=0.02) during antiviral therapy and at follow-up in patients achieving SVR. A similar trend, even if not significant, was observed in relapsers and non-responders.


CONCLUSIONS
In non-diabetic G1 HCV patients undergoing antiviral therapy, IR improved in all patients, independently of virological outcome. HCV viral clearance was an additional factor in IR improvement. Female gender, hepatic steatosis and other metabolic parameters, but not IR, were identified as negative predictors of SVR in this study.
Petta
Salvatore
S
Cattedra ed Unità Operativa di Gastroenterologia, Università di Palermo, Palermo, Italy. petsa@inwind.it
Cammà
Calogero
C
Di Marco
Vito
V
Cabibi
Daniela
D
Ciminnisi
Stefania
S
Caldarella
Rosalia
R
Licata
Anna
A
Massenti
Maria Fatima
MF
Marchesini
Giulio
G
Craxì
Antonio
A
D000998:Antiviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D005234:Fatty Liver / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D006801:Humans; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055105:Waist Circumference
D000998:Antiviral Agents