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Gut 2009;58:1654-1660 doi:10.1136/gut.2009.179085
  • Hepatology

Insulin resistance is associated with liver stiffness in HIV/HCV co-infected patients

  1. N Merchante1,
  2. A Rivero2,
  3. I de los Santos-Gil3,
  4. D Merino4,
  5. M Márquez5,
  6. M Á López-Ruz6,
  7. J Rodríguez-Baño7,
  8. J del Valle8,
  9. Á Camacho9,
  10. J Sanz-Sanz10,
  11. J Macías11,
  12. I Pérez-Camacho12,
  13. J Gómez-Mateos13,
  14. A Moro14,
  15. J A Pineda1
  1. 1
    Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain
  2. 2
    Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
  3. 3
    Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital La Princesa, Madrid, Spain
  4. 4
    Servicio de Medicina Interna, Hospital Juan Ramón Jiménez, Huelva, Spain
  5. 5
    Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
  6. 6
    Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
  7. 7
    Sección de Enfermedades Infecciosas. Hospital Universitario Virgen Macarena, Sevilla, Spain
  8. 8
    Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain
  9. 9
    Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
  10. 10
    Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital La Princesa, Madrid, Spain
  11. 11
    Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain
  12. 12
    Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
  13. 13
    Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain
  14. 14
    Servicio de Bioquímica, Hospital Universitario de Valme, Seville, Spain
  1. Correspondence to Dr J A Pineda, Unidad de Enfermedades Infecciosas. Hospital Universitario de Valme. Avenida de Bellavista, s/n. 41014 Sevilla, Spain; japineda{at}telefonica.net
  • Revised 16 March 2009
  • Accepted 31 March 2009
  • Published Online First 21 July 2009

Abstract

Background: The factors that influence liver fibrosis progression in patients co-infected with human immunodeficiency virus/hepatitis C virus (HIV/HCV) are not completely understood. It is not known if insulin resistance (IR), a condition that promotes liver fibrosis in HCV mono-infected individuals, is one of these factors.

Objective: To evaluate the association between IR and liver stiffness (LS).

Design: Multicentre cross-sectional study.

Patients: 330 patients co-infected with HIV/HCV.

Methods: LS was assessed by transient elastography, which has shown a high accuracy to predict significant fibrosis in patients co-infected with HIV/HCV. The outcome variable of the study was LS. Patients with LS≥9 kPa were considered as having significant fibrosis. IR was calculated using the HOMA method.

Results: LS was ≥9 kPa in 150 (45%) patients. HOMA correlated with LS (Spearman’s rho correlation coefficient, 0.37; p<0.0001). The median (Q1–Q3) HOMA in patients with LS≥9 kPa was 3.30 (2.17–5.16) while it was 2.09 (1.37–3.22) in patients with LS <9 kPa (p<0.0001). Ninety-six (39%) individuals with a HOMA <4 and 54 (63%) with a HOMA ≥4 showed LS≥9 kPa (p<0.0001). Analyses after excluding patients with cirrhosis yielded similar results. After multivariate analyses, age ≥40 years (adjusted odds ratio (AOR), 1.85; 95% confidence interval (CI), 1.03 to 3.29; p = 0.03), CD4 cell count <200 cells/ml (AOR, 3.45; 95% CI, 1.67 to 7.11; p = 0.001), hepatitis B virus co-infection (AOR, 9.25; 95% CI, 2.42 to 35.31; p = 0.001), and HOMA ≥4 (AOR, 5.33; 95% CI, 2.70 to 10.49; p<0.0001) were the independent predictors of LS≥9 kPa.

Conclusion: IR is associated with LS in patients co-infected with HIV/HCV.

Footnotes

  • Funding This study has been partly supported by grants from the Consejería de Salud de la Junta de Andalucía (Reference 0011/07) and from the Fundación para la Investigación y la Prevención del SIDA en España (FIPSE) (Expte. 12705/07). The authors wish to thank the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Red de SIDA from Spain for their support (ISCIII-RETIC RD06/006).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • See Commentary, p 1578

  • Ethics approval The Ethics Committee of the Hospital Universitario de Valme approved the study, on 6 September 2007.

This Article

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    2. 58/12/1654 most recent

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