Clinical-liver, pancreas, and biliary tractInsulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients
Section snippets
Patient population
Consecutive patients from 5 Spanish hospitals were recruited and treated according to standard daily clinical practice. Patients (n = 159; 94 men [59.1%] and 65 women [41.9%]; mean age, 41.7 ± 11.1 years; range, 22–67 years) with biopsy-proven chronic hepatitis C, showing HCV RNA-positive and altered alanine aminotransferase levels, were treated with peginterferon plus ribavirin (alfa-2a, n = 85; alfa-2b, n = 74). Genotype distributions were as follows: genotype 1, n = 113; genotype 2, n = 7;
Factors associated with sustained virological response
Patients with SVR were younger (39.7 ± 10.4 years vs. 44.5 ± 10.9 years; P = .006), had a lower HOMA-IR (2.36 ± 1.85 vs. 3.76 ± 3.22; P = .001), had a lower BMI (25.4 ± 3.65 kg/m2 vs. 27.1 ± 4.89 kg/m2; P = .027), had lower γ-glutamyltranspeptidase levels (46.8 ± 49.5 U/L vs. 106.7 ± 107.2 U/L; P = .001), and had lower serum leptin levels in men (5.1 ± 3.97 ng/mL vs. 12.4 ± 13.7 ng/mL; P = .048) and in women (13.3 ± 10.5 ng/mL vs. 20.5 ± 13.5 ng/mL; P = .016). There was no association with sex
Discussion
Insulin resistance, advanced fibrosis, and genotype 1 are independent predictors of a poor response to antiviral therapy in chronic hepatitis C. It is interesting to note that insulin resistance seems to be a common denominator among groups of poor-response patients, such as those with cirrhosis4 or a high BMI,13 African Americans,14 and those with HIV/HCV co-infection.15 Whether insulin resistance is a marker for patients who are very difficult to treat or whether it plays a role in interferon
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Cited by (0)
This study was funded, in part, by grants from Consejería de Salud de la Junta de Andalucía (43/03 and PAI-532) and the Spanish Ministry of Health (G03/155-2002 and C03/02-2002).