title: Insulin resistance is associated with progression to hepatic fibrosis in a cohort of HIV/hepatitis C virus-coinfected patients.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) infection is associated with higher insulin levels and insulin resistance. We evaluated factors associated with insulin resistance in a cohort of HIV/HCV-coinfected patients and determined the effect of insulin resistance on the development of hepatic fibrosis.
  
  
  METHODS
  Data were analysed from 158 nondiabetic participants in a prospective Canadian cohort of HIV/HCV-coinfected patients. Patients were defined as having insulin resistance using the homeostasis model for assessment of insulin resistance (HOMA-IR) index. Factors associated with a high index (HOMA-IR ≥ 2) were identified using multivariate logistic regression. Incidence rates of liver fibrosis [aspartate aminotransferase- to-platelet ratio index (APRI) ≥ 1.5] were calculated, and multivariate time-dependent Cox regression models used to assess the effect of baseline insulin resistance on the risk of developing an APRI score of at least 1.5 during follow-up.
  
  
  RESULTS
  Overall, 56% had baseline HOMA-IR of at least 2. In the adjusted multivariate logistic analysis, only baseline BMI of more than 25 kg/m2 remained associated with insulin resistance [adjusted odds ratio 3.66, 95% confidence interval (CI) 1.70-7.92]. Rates of progression to significant hepatic fibrosis (APRI ≥ 1.5) were higher in those with HOMA-IR of at least 2 (16.32 per 100 person-years, 95% CI 6.68-25.97) compared with those with HOMA-IR less than 2 (7.95 per 100 person-years, 95% CI 0.16-15.75). Baseline HOMA-IR of at least 2 was associated with the development of significant fibrosis (adjusted hazard ratio 7.71, 95% CI 2.55-23.36).
authors: British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Mark W
authors: MW
authors: Hull
authors: Kathleen
authors: K
authors: Rollet
authors: Erica E M
authors: EE
authors: Moodie
authors: Sharon
authors: S
authors: Walmsley
authors: Joseph
authors: J
authors: Cox
authors: Martin
authors: M
authors: Potter
authors: Curtis
authors: C
authors: Cooper
authors: Neora
authors: N
authors: Pick
authors: Sahar
authors: S
authors: Saeed
authors: Marina B
authors: MB
authors: Klein
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D060085:Coinfection; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006679:HIV Seropositivity / Q000453:epidemiology / Q000378:metabolism*; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology* / Q000821:virology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies