The negative role of insulin resistance for sustained virological response in chronic hepatitis C patients

Background: The response to pegylated interferon (PEG-IFN) and ribavirin (RBV) treatment in chronic hepatitis C (CHC) is influenced by various factors. Insulin resistance (IR), hepatic steatosis and overweight are associated with poor results.

Aim: to analyze the association between the parameters of IR and the response to the antiviral treatment in CHC patients.

Patients and methods: 87 CHC patients (37 male, M/50 female, F; each genotype 1), mean age 46.8 (18–65) years were involved into the study. 19 patients had type 2 diabetes mellitus. Body weight, BMI (body mass index), waist circumference, HOMA (homeostasis assessment model) index, serum glucose and insulin levels were measured before the treatment. Liver biopsy was performed in 80 patients. Liver steatosis proved histologically was also considered. We compared these parameters both groups of responder and nonresponder patients.

Results: The mean body weight was 74.5kg; BMI 26.4; waist circumference 94cm (M); 88cm (F). The mean HOMA index was 4.6 (high). Overall sustained viral response (SVR) rate was 36% (M:27%, F:42%). High waist circumference was associated with low (33%) SVR, especially in males (21%). In patients with high HOMA values (>2.5) the rate of SVR was low (18/58, 31%) and hepatic steatosis was more common (47/55, 85%). SVR rate among the diabetic patients was only 16% (3/19). Poor SVR was detected in patients with abnormal ALT levels at week 12 (7/44, 16%).

Conclusion: IR and diabetes mellitus, high HOMA index, hepatic steatosis, high waist circumference and abnormal ALT at week 12 are the best negative host predictors of the sustained virological response beyond the virological factors (genotype, viral load). Prospective, large patient number studies are needed to evaluate the accurate role of the IR in sustained virological response in CHC patients.