title: Insulin resistance: a major factor associated with significant liver fibrosis in Egyptian patients with genotype 4 chronic hepatitis C.
abstract: OBJECTIVE
  The role of insulin resistance (IR) in chronic hepatitis C genotype 4 (CHC-4) patients is still under assessment. The aims of this study are to assess the prevalence and predictors of IR and its influence along with clinical, metabolic, virological, and histological factors on the severity of liver fibrosis in 100 Egyptian patients with CHC-4.
  
  
  METHODS
  In 100 untreated patients with CHC-4, IR was assessed using the Homeostasis Model Assessment and defined greater than 3. By logistic regression (LR), independent factors associated with IR and significant fibrosis (SF=fibrosis, Metavir score≥F2) were assessed in nondiabetic and noncirrhotic patients.
  
  
  RESULTS
  One hundred patients were included; 54% were men and 46% were women. The mean age of the patients was 40.46±9.41 years. Of the total patients, 55% were overweight and 28% were obese. Metabolic syndrome was observed in 26% of patients; five of them were known to be diabetic. All patients were genotype 4. Most of our patients had mild viremia (<2 00 000 IU/ml), whereas only 16% had higher viral load (>2 00 000 IU/ml). There was no correlation between IR and hepatitis C virus viremia (r=-0.069; P=0.492). Necroinflammation was moderate-severe (A2-A3) in 25% of patients. SF (F2-F4) was found in 46% of patients and 11% had cirrhosis (F4). Most of our patients, 54%, had moderate steatosis and 21% had severe steatosis. IR was present in 46% of patients; 39 (42.9%) were nondiabetic, which is correlated significantly with BMI (r=0.395; P<0.01). IR was found to increase significantly with the fibrosis stage (P=0.001), insignificant fibrosis, 18.5%, SF (F2-F4), 71.4%, and cirrhosis (F4), 100%. By LR, IR was independently and significantly associated with age more than 40 years, obesity (BMI>30 kg/m), SF, and severe steatosis (>30%). IR was also significantly associated with metabolic syndrome. SF was present in 46 patients (46%). It was associated with IR, moderate-severe necroinflammation, and severe steatosis. By LR, in noncirrhotic patients, SF was associated with age more than 40 years, obesity (BMI>30 kg/m), moderate/severe liver inflammation, and severe steatosis.
  
  
  CONCLUSIONS
  In CHC-4 patients, IR is highly prevalent and independently associated with age, obesity, SF, and severe steatosis. Management of IR might significantly improve the prognosis of CHC-4 patients.
authors.affiliation: Departments of Hepatogastroenterology, Theodor Bilharz Research Institute, Giza 12411, Egypt. ahmedelray@hotmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: El Ray
authors.forename: Tarik
authors.initials: T
authors.lastname: Asselah
authors.forename: Rami
authors.initials: R
authors.lastname: Moucari
authors.forename: Maged
authors.initials: M
authors.lastname: El Ghannam
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Taha
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Saber
authors.forename: Maha
authors.initials: M
authors.lastname: Akl
authors.forename: Raafat
authors.initials: R
authors.lastname: Atta
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shemis
authors.forename: Azza S
authors.initials: AS
authors.lastname: Radwan
authors.forename: Ayman
authors.initials: A
authors.lastname: Ghali
authors.forename: Valerie
authors.initials: V
authors.lastname: Paradis
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D005234:Fatty Liver / Q000503:physiopathology / Q000821:virology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008103:Liver Cirrhosis / Q000473:pathology / Q000503:physiopathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index