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and Hepatitis.com Coverage of the
50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010)
Insulin Resistance Linked to Poor Hepatitis C Treatment Response in HIV/HCV Coinfected Patients
Prior research has shown that HIV positive people coinfected with hepatitis C tend to experience more rapid liver disease progression and are less likely to respond to interferon-based therapy compared to individuals with chronic hepatitis C alone.
Insulin resistance -- a precursor to diabetes -- is also a predictor of poorer treatment response in patients with HCV alone, but this association has not been extensively evaluated in people with HIV/HCV coinfection.
In a prospective observational study, Paola Nasta and colleagues from the University of Brescia in Italy looked at the correlation between HCV RNA viral load, hepatitis C treatment response, and insulin resistance in 107 HIV/HCV coinfected patients.
Most participants (about 85%) were men and the average age was about 43 years. Half had hard-to-treat HCV genotypes 1 or 4, and nearly 60% had advanced liver fibrosis (Metavir stage F3-F4). Almost all patients (93%) were taking combination antiretroviral therapy (ART).
Participants received a hepatitis C treatment regimen consisting of 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-adjusted ribavirin. HCV viral load was measured at baseline and then every 3 months. The researchers assessed sustained virological response (SVR), or continued undetectable HCV RNA 24 weeks after finishing therapy.
Insulin resistance was evaluated using the HOMA-IR (homeostasis model of assessment-insulin resistance) method, which is calculated based on fasting insulin level. At baseline, the average HOMA-IR score was 3.2; a score > 3.0 is typically considered the threshold for insulin resistance.
These findings led the investigators to conclude, "A linear relationship was detected between HOMA-IR and hepatitis C viral load in HIV/HCV coinfected [patients] regardless viral genotype."
"This result could contribute to explain[ing] the role of insulin-resistance on the anti-HCV treatment outcome in HIV/HCV coinfected persons," they suggested.
University of Brescia, Brescia, Italy.