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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