Insulin resistance is not a relevant predictor of sustained virological response to pegylated interferon plus ribavirin in HIV/HCV co-infected patients☆

Background/Aims

To evaluate the possible influence of baseline insulin resistance in sustained virological response.

Methods

One hundred and fifty-five consecutive individuals from a multicentric cohort of HIV/HCV co-infected patients who underwent therapy with pegylated interferon plus ribavirin were included. The main outcome variable was sustained virological response, defined as undetectable plasma HCV RNA at week 24 after the end of the therapy. Insulin resistance was determined using the HOMA method.

Results

Sustained virological response was achieved in 55 (36%) patients. Forty-two (38%) patients with a HOMA lower than 4 developed sustained virological response vs 13 (29%) of those with a HOMA above 4 (p=0.27). Analyses restricted to patients harbouring genotype 1 or 4 showed similar rates of sustained virological response among patients with a HOMA below and above 4 [19 (27%) vs 7 (24%); p=0.8]. In the multivariate analysis, genotype 3 [AOR 9.26; 95% CI 3.03–28.30; p<0.0001], a baseline HCV viral load below 600.000IU/mL [AOR 2.97; 95% CI 1.03–8.57; p=0.04] and baseline LDL cholesterol above 100mg/dL [AOR 6.62; 95% CI 1.97–22.19; p=0.002] were independently associated with sustained virological response.

Conclusions

Insulin resistance is not a relevant predictor of sustained virological response to pegylated interferon plus ribavirin in HIV/HCV co-infected patients.

Abbreviations: HAART, highly active antiretroviral therapy, HCV, hepatitis C virus, SVR, sustained virological response, IR, insulin resistance, CHC, chronic hepatitis C, ETR, end of treatment response, HOMA, homeostasis model assessment, BMI, body mass index, ALT, alanine-aminotransferase, LDL, low-density lipoprotein, HDL, high-density lipoprotein, AOR, adjusted odds ratio, CI, confidence interval, EVR, early virological response, RVR, rapid virological response

Keywords: HIV/HCV co-infection, HOMA, Insulin resistance, Pegylated interferon, SVR