Journal of Hepatology
Volume 48, Issue 1 , Pages 28-34, January 2008

Insulin resistance and response to therapy in patients infected with chronic hepatitis C virus genotypes 2 and 3☆

  • Hossein Poustchi

      Affiliations

    • Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, NSW, Australia
    • Digestive Disease Research Centre, Shartati Hospital, Medical Science/University of Tehran, Iran
    • ,
  • Francesco Negro

      Affiliations

    • Divisions of Clinical Pathology and Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland
    • ,
  • Jason Hui

      Affiliations

    • Department of Medicine, University of New South Wales, Australia
    • ,
  • Ian Homer Y. Cua

      Affiliations

    • Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, NSW, Australia
    • ,
  • Laura Rubbia Brandt

      Affiliations

    • Divisions of Clinical Pathology and Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland
    • ,
  • James G. Kench

      Affiliations

    • Department of Tissue Pathology, Westmead Hospital, NSW, Australia
    • ,
  • Jacob George

      Affiliations

    • Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, NSW, Australia
    • Corresponding Author InformationCorresponding author. Tel.: +61 298457705; fax: +61 296357582.

Received 20 March 2007; received in revised form 4 July 2007; accepted 5 July 2007. published online 28 September 2007.

Associate Editor: M.U. Mondelli

Background/Aims

Obesity is associated with impaired treatment responses in chronic hepatitis C. The aim of this study was to determine the relationship between the insulin resistance frequently seen in obese subjects and sustained virological response to anti-viral therapy (SVR) in patients with genotype 2 or 3 infection.

Methods

Eighty-two patients were studied; 59 received interferon/ribavirin while 23 received peg-interferon/ribavirin.

Results

The overall SVR was (77%). Patients with a SVR had lower mean serum insulin (10.7±0.8μU/ml vs. 22.2±4.9; P=0.03), fibrosis stage (1.9±0.1 vs. 2.7±0.3; P=0.007) and insulin resistance measured by the homeostasis model (HOMA-IR) (2.5±0.2 vs. 6.1±1.5; P=0.03). Age, gender, ethnicity, alcohol consumption, treatment regimen, viral load, portal activity and steatosis did not influence the SVR. By linear regression, body mass index (P<0.001) and fibrosis stage (P<0.001) were independently associated with HOMA-IR. After adjusting for fibrosis stage, patients with HOMA-IR of <2 were 6.5 times more likely to achieve SVR than those with HOMA-IR⩾2.

Conclusions

Even in treatment-responsive genotypes 2 and 3, high HOMA-IR is associated with a reduced response. Improving insulin sensitivity may be a useful adjunct to anti-viral therapy in these individuals.

Keywords: Hepatitis C treatment, Insulin resistance, Genotype 2 and 3 hepatitis C

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☆ The authors declared that Schering Plough and Roche have provided unrestricted grants to support the units. This study is supported in part by Grants 219282 and 358398 from the National Health and Medical Research Council of Australia, Grant DK98017 from the National Institutes of Health, USA, Grant No. 3200B0-103727/1 from the Swiss National Science Foundation and by a research award from the Leenaards Foundation (Lausanne, Switzerland). They did not receive any funding from Roche or Schering Plough to undertake this research study.

PII: S0168-8278(07)00508-9

doi:10.1016/j.jhep.2007.07.026

Journal of Hepatology
Volume 48, Issue 1 , Pages 28-34, January 2008

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