title: Insulin resistance impairs response to interferon plus ribavirin in patients coinfected with HIV and hepatitis C virus.
abstract: OBJECTIVE
  Controversy exists about whether insulin resistance (IR) affects response to treatment of hepatitis C. We evaluated the effect of IR on sustained virologic response (SVR) in HIV/hepatitis C virus (HCV)-coinfected patients treated with interferon plus ribavirin.
  
  
  METHODS
  We reviewed the clinical records of HIV/HCV-coinfected patients who received interferon plus ribavirin at our institution between July 2000 and March 2007. IR was defined as a homeostasis model assessment ≥ 3.8. SVR was defined as an undetectable HCV RNA at 24 weeks after the end of treatment. Efficacy was evaluated using an on-treatment (OT) analysis. Multivariate logistic regression analysis was used to evaluate factors associated with SVR.
  
  
  RESULTS
  During the study period, 218 patients were treated with interferon plus ribavirin; IR at baseline was available for 162 patients, and 134 were included in the OT analysis; HCV genotype (G) 1/4, 67%; F3-F4 fibrosis, 36%; IR 31%. SVR was achieved in 67 patients (50%) (79% in G 2/3 vs. 38% in G 1/4). IR was associated with a lower SVR [odds ratio (OR), 0.33; 95% confidence interval (CI): 0.15-0.72; P = 0.006). The independent variables related to SVR were genotype 2/3 (OR, 6.7; 95% CI: 2.71-16.98; P < 0.001), absence of IR at baseline (OR, 3.3; 95% CI: 1.36-8.26; P = 0.008), and nadir CD4 T-cell count (OR, 1.002; 95% CI: 1.00-1.00; P = 0.047).
  
  
  CONCLUSIONS
  Our data suggest that IR is an important determinant of SVR in HIV/HCV-coinfected patients treated with interferon plus ribavirin. Strategies to modify IR should be explored to enhance SVR during anti-HCV therapy.
authors.affiliation: Department of Microbiology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ryan
authors.forename: Salvador
authors.initials: S
authors.lastname: Resino
authors.forename: Pilar
authors.initials: P
authors.lastname: Miralles
authors.forename: Jaime
authors.initials: J
authors.lastname: Cosín
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: López
authors.forename: Silvia
authors.initials: S
authors.lastname: Moreno
authors.forename: Pilar
authors.initials: P
authors.lastname: Catalán
authors.forename: Margarita
authors.initials: M
authors.lastname: Ramírez
authors.forename: Isabel
authors.initials: I
authors.lastname: Gutiérrez
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015153:Blotting, Western; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007333:Insulin Resistance; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D019562:Viral Load / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a