Insulin Resistance Linked to Lower Treatment Response in Genotype 2/3 Patients
It
is increasingly clear that hepatitis C virus (HCV)
infection is associated with obesity, altered fat and glucose processing,
and other metabolic abnormalities, though the link are not fully understood. Further,
obesity is associated with impaired response to interferon-based therapy.
In
the present study, described in the January 2008 Journal of Hepatology,
researchers aimed to determine the relationship between the insulin resistance
frequently seen in obese patients and sustained virological response (SVR) to
antiviral therapy in patients with genotype 2 or 3 HCV. The study included 82
treated participants; 59 received conventional
interferon and 23 received pegylated interferon,
all in combination with ribavirin.
Results
•
The overall SVR rate was 77%.
•
Patients who achieved SVR had lower mean serum insulin (10.7 vs 22.2 mcU/ml; P
= 0.03), fibrosis stage (1.9 vs 2.7; P = 0.007), and insulin resistance measured
according to the homeostasis model (HOMA-IR) (2.5 vs 6.1; P = 0.03).
•
Likelihood of SVR was not significantly associated with patient age, sex, race/ethnicity,
alcohol consumption, treatment regimen, HCV viral load, portal activity, or presence
of liver steatosis (fat accumulation).
•
By linear regression, body mass index (P < 0.001) and fibrosis stage (P <
0.001) were independently associated with HOMA-IR score.
•
After adjusting for fibrosis stage, patients with HOMA-IR < 2 were 6.5 times
more likely to achieve SVR than those with HOMA-IR > 2.
Conclusion
"Even
in treatment-responsive genotypes 2 and 3, high HOMA-IR is associated with a reduced
response," the authors wrote. "Improving insulin sensitivity may be
a useful adjunct to antiviral therapy in these individuals."
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.
02/01/08
Reference H
Poustchi, F Negro, J Hui, and others. Insulin resistance and response to therapy
in patients infected with chronic hepatitis C virus genotypes 2 and 3. Journal
of Hepatology 48(1): 28-34. January 2008.
It
is increasingly clear that 
