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Insulin resistance is associated with liver stiffness in HIV/HCV-coinfected patients
  1. Nicolás Merchante (nicolasmerchante{at}hotmail.com)
  1. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain
    1. Antonio Rivero (ariveror{at}gmail.com)
    1. Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
      1. Ignacio de los Santos-Gil (isantosg{at}hotmail.com)
      1. Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital La Princesa, Madrid, Spain
        1. Dolores Merino (lmerino2001{at}terra.es)
        1. Servicio de Medicina Interna, Hospital Juan Ramón Jiménez, Huelva, Spain
          1. Manuel Márquez (med000856{at}gmail.com)
          1. Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
            1. Miguel A López-Ruz (mangel.lopez.sspa{at}juntadeandalucia.es)
            1. Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
              1. Jesús Rodríguez-Baño (jesusrodriguez{at}medynet.com)
              1. Sección de Enfermedades Infecciosas. Hospital Universitario Virgen Macarena, Sevilla, Spain
                1. José del Valle (joselric{at}hotmail.com)
                1. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain
                  1. Angela Camacho (acamachoespejo{at}gmail.com)
                  1. Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
                    1. Jesús Sanz-Sanz (jsanz.hlpr{at}salud.madrid.org)
                    1. Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital La Princesa, Madrid, Spain
                      1. Juan Macías (jmacias{at}cica.es)
                      1. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain
                        1. Inés Pérez-Camacho (inpercam{at}hotmail.com)
                        1. Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
                          1. Jesús M Gómez-Mateos (gomez_mateos{at}telefonica.net)
                          1. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain
                            1. Antonio Moro (antonio.moro.sspa{at}juntadeandalucia.es)
                            1. Servicio de Bioquímica, Hospital Universitario de Valme, Sevilla, Spain
                              1. Juan A Pineda (japineda{at}telefonica.net)
                              1. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain

                                Abstract

                                Background: The factors that influence liver fibrosis progression in HIV/HCV-coinfected patients are not completely understood. It is not known if insulin resistance (IR), a condition that promotes liver fibrosis in HCV-monoinfected individuals, is one of these factors.

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

                                Design: Multicenter cross-sectional study.

                                Patients: 330 HIV/HCV-coinfected patients.

                                Methods: LS was assessed by transient elastography, which has shown a high accuracy to predict significant fibrosis in HIV/HCV-coinfected patients. The outcome variable of the study was LS. Patients with LS ≥ 9 kiloPascals (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) 1.03-3.29; p=0.03], CD4 cell count < 200 cells/mL [AOR 3.45; 95% CI 1.67-7.11; p=0.001], hepatitis B virus coinfection [AOR 9.25; 95% CI 2.42-35.31; p=0.001], and HOMA ≥ 4 [AOR 5.33; 95% CI 2.70-10.49; p<0.0001] were the independent predictors of LS ≥ 9 kPa.

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

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