Insulin resistance impairs sustained virological response rate to pegylated interferon plus ribavirin in HIV-hepatitis C virus-coinfected patients: HOMAVIC-ANRS HC02 Study.
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.
Cacoub
Patrice
P
Université Pierre et Marie Curie-Paris 6, CNRS, UMR 7087, Paris, France. patrice.cacoub@psl.aphp.fr
Carrat
Fabrice
F
Bédossa
Pierre
P
Lambert
Jérôme
J
Pénaranda
Guillaume
G
Pol
Stanislas
S
Halfon
Philippe
P
D000328:Adult; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007333:Insulin Resistance; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*
D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b