Influence of insulin resistance on hepatic fibrosis and steatosis in hepatitis C virus (HCV) mono‐infected compared with HIV–HCV co‐infected patients

Summary Background  Insulin resistance (IR), the major feature of the metabolic syndrome, is also common in patients with chronic HCV infection. Liver fibrosis and steatosis are known potential outcome of chronic hepatitis B or C infection. Studies have shown that HIV positive individuals co‐infecte...

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Published in:Alimentary pharmacology & therapeutics 2009-07, Vol.30 (1), p.61-70
Main Authors: HALFON, P., PÉNARANDA, G., CARRAT, F., BEDOSSA, P., BOURLIÈRE, M., OUZAN, D., RENOU, C., TRAN, A., ROSENTHAL, E., WARTELLE, C., DELASALLE, P., CACOUB, P.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Digestive system
Fatty Liver - etiology
Fatty Liver - physiopathology
Female
Gastroenterology. Liver. Pancreas. Abdomen
Hepatitis C virus
Hepatitis C, Chronic - complications
HIV Infections - complications
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Insulin Resistance
Liver Cirrhosis - etiology
Liver Cirrhosis - physiopathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Pharmacology. Drug treatments
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Young Adult
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Summary:Summary Background  Insulin resistance (IR), the major feature of the metabolic syndrome, is also common in patients with chronic HCV infection. Liver fibrosis and steatosis are known potential outcome of chronic hepatitis B or C infection. Studies have shown that HIV positive individuals co‐infected with HCV have more rapid live disease progression than those with HIV alone. Few data have reported the influence of IR on steatosis and fibrosis in the context of HIV‐HCV coinfection. Aim  To test the association among insulin resistance (IR), liver fibrosis and liver steatosis in HIV–HCV and HCV‐infected patients. Patients and methods  A total of 170 HIV–HCV‐infected patients matched by age, gender and genotype with 170 HCV mono‐infected patients were included. Patients were considered to be IR when the homeostasis model assessment of IR >2. Significant fibrosis was considered if METAVIR ≥F2 and significant steatosis if ≥10%. Results  Insulin resistance was independently associated in HCV patients with fibrosis [odds ratio (OR) = 2.04 (95% CI 1.02–4)], a body mass index (BMI) >25 kg/m² [OR = 3.33 (1.47–7.69)] and steatosis [OR = 3.33 (1.67–6.67)]. Fibrosis ≥F2 was associated in HCV patients with high liver activity grade (≥A2) [OR = 8.33 (3.85–16.67)], male gender [OR = 3.03 (1.33–7.14)] and IR [OR = 2.44 (1.15–5)]. In HIV–HCV patients, ≥A2 [OR = 5.56 (1.64–20)] was associated with fibrosis. Steatosis ≥10% was associated in HCV patients with IR [OR = 3.13 (1.59–6.25) and ≥F2 (OR = 2.22 (1.15–4.17)]. In HIV–HCV, a BMI >25 kg/m² [OR = 3.85 (1.64–9.10)], ≥A2 [OR = 2.16 (1.02–4.55); P = 0.044] and nucleoside reverse transcriptase inhibitor [OR = 3.61 (1.19–10.96); P = 0.023] were independently associated with significant liver steatosis. Conclusions  Insulin resistance is associated with liver fibrosis and steatosis in HCV mono‐infected, but not in HIV–HCV co‐infected patients. Significant liver fibrosis is associated with IR independent of liver steatosis only in HCV mono‐infected patients.
ISSN:0269-2813
1365-2036
DOI:10.1111/j.1365-2036.2009.03995.x