Department of Gastroenterology and Hepatology, Royal North Shore Hospital, Sydney, Australia.
BACKGROUND AND AIMS:
Insulin resistance (IR) is a key factor in the development of hepatic steatosis and fibrosis in chronic hepatitis C infection (HCV). Little is known about the impact of viral clearance on IR. The aim of this study was to determine the impact of viral clearance on IR.
86 patients treated according to standard clinical practice at an Australian teaching hospital between 2003 and 2007 were prospectively studied. Demographic, biochemical, and histological data were collected.
The mean pre-treatment HOMA-IR was similar in the SVR and non-SVR groups (2.7±0.5 and 2.8±0.4 respectively) and both values were consistent with significant IR. There was a significant improvement in HOMA-IR (from 3.0±1.0 to 2.2±0.5, p=0.04) at the end of treatment in the SVR group only. This trended towards significance at six months post treatment. Multiple regression analysis found improvement in both GGT and ALT predicted improvement in HOMA-IR when controlled for other potential factors (p=0.01).
HCV clearance is associated with improvement in IR. Although baseline hepatic fibrosis is a predictor of IR, changes in IR appear to be independent of changes in liver fibrosis. Treatment related improvement in GGT and ALT seen with improved IR may be a possible marker of reduction of hepatic oxidative stress.