Clinical Advances in Liver, Pancreas, and Biliary TractChanges in Insulin Sensitivity and Body Weight During and After Peginterferon and Ribavirin Therapy for Hepatitis C
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Patient Population
The Virahep-C study was a multicenter study of combination peginterferon and ribavirin therapy of chronic hepatitis C designed to assess the rates and predictors of response among African American and white American patients with HCV genotype 1 infection and to identify reasons for nonresponse to therapy. The design and primary outcomes of the Virahep-C trial have been reported.15, 18 Adult patients who were 18 years and older, who had not been previously treated, who were infected with HCV
Baseline Features Associated With Insulin Resistance
Among the 401 patients enrolled into the Virahep-C study, 341 (168 African Americans and 173 white Americans) had calculable HOMA values at baseline. Of these, 135 (40%) had insulin resistance as defined by a HOMA2-IR value of greater than 2.0. The frequency of insulin resistance was 46% among African Americans compared with 34% in white Americans (P = .026). Other factors that were significantly (P < .05) associated with the presence of insulin resistance at baseline included history of
Discussion
In this prospective study of therapy of chronic hepatitis C genotype 1, 40% of patients were found to have insulin resistance at baseline. The presence of insulin resistance correlated with higher body weight, higher serum triglycerides, and greater degrees of fibrosis and steatosis on liver biopsy, all of which are well-known risk factors for diabetes and insulin resistance. Because of the lack of a suitable control group, it is not clear whether this rate of insulin resistance was higher than
References (26)
- et al.
Evidence for a link between hepatitis C virus infection and diabetes mellitus in a cirrhotic population
J Hepatol
(1994) - et al.
Hepatitis C virus down-regulates insulin receptor substrates 1 and 2 through up-regulation of suppressor of cytokine signaling 3
Am J Pathol
(2004) - et al.
Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity
Hepatology
(2001) - et al.
Insulin resistance is associated with chronic hepatitis C and virus infection fibrosis progression
Gastroenterology
(2003) - et al.
Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients
Gastroenterology
(2005) - et al.
Hepatitis steatosis in hepatitis C: comparison of diabetic and nondiabetic patients in the hepatitis C antiviral long-term treatment against cirrhosis trial
Clin Gastroenterol Hepatol
(2007) - et al.
Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma
Gastroenterology
(2004) - et al.
Histological grading and staging of chronic hepatitis
J Hepatol
(1995) - et al.
Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance
Gastroenterology
(2004) - et al.
Effects of long-term interferon-α treatment on glucose tolerance in patients with chronic hepatitis C
J Hepatol
(1999)
The prevalence of hepatitis C virus infection in the United States, 1999 through 2002
Ann Intern Med
Diagnosis, management, and treatment of hepatitis C: an update
Hepatology
Association of diabetes mellitus and chronic hepatitis C virus infection
Hepatology
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) with cosupport from the National Center on Minority Health and Health Disparities (NCMHD) and the Intramural Research Program of the National Cancer Institute (NCI) with further support under a Cooperative Research and Development Agreement (CRADA) with Roche Laboratories, Inc. Clinical trial number: NCT00038974 (URL: http://www.virahepc.org). Grant numbers: U01 DK60329, U01 DK60340, U01 DK60324, U01 DK60344, U01 DK60327, U01 DK60335, U01 DK60352, U01 DK60342, U01 DK60345, U01 DK60309, U01 DK60346, U01 DK60349, U01 DK60341. Other support includes the National Center for Research Resources (NCRR) General Clinical Research Centers Program grants: M01 RR00645 (New York Presbyterian), M02 RR000079 (University of California, San Francisco), M01 RR16500 (University of Maryland), M01 RR000042 (University of Michigan), M01 RR00046 (University of North Carolina).