Insulin resistance is a negative predictive factor 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 a number of factors. Insulin resistance (IR), hepatic steatosis and overweight is associated with poor outcome. Aim: We aimed to analyze the association between parameters of IR and the response to the antiviral treatment in CHC patients. Patients and methods: Fifty CHC patients (25 male, M/25 female, F, each genotype 1b), mean age 46.1 (18–65) years were involved into the study. Ten patients had type 2 diabetes mellitus. Body weight, BMI (body mass index), waist circumference, HOMA A (homeostasis assessment model) index, serum glucose, and insulin levels were measured before the treatment. Liver biopsy was performed in 43 patients. Data of patients with histologically proved fatty liver were compared with that of without steatosis. We compared the above parameters in the groups of responder and nonresponder patients. Results: The mean body weight was 75kg, the BMI 26.7; the waist circumference 94.4cm (M); 90cm (F). The mean HOMA index was high (4.5). The overall sustained viral response (SVR) rate was 38% (28% in M, 48% in F). High waist circumference was associated with low SVR (7/26; 27%). In patients with high HOMA values (>2.5) the rate of SVR was low (11/32, 32%) and the severe hepatic steatosis was more common (25/34; 74%). Higher HOMA values were the consequence of elevated insulin levels and not that of glucose. SVR was detected only in 12% (3/25) in patients with high ALT levels at week 12. Conclusion: Elevated HOMA index, hepatic steatosis, larger waist circumference and abnormal ALT at week 12 are the strongest negative predictors of the sustained virological response beyond the virological factors (genotype, viral load). Prospective, large patient number studies are needed to evaluate the role of the IR in sustained virological response in CHC patients.