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Insulin resistance impairs rapid virologic response in HIV/hepatitis C virus coinfected patients on peginterferon-alfa-2a

Nasta, Paola; Gatti, Francesca; Puoti, Massimo; Cologni, Giuliana; Bergamaschi, Viviana; Borghi, Federica; Matti, Alessandro; Ricci, Antonella; Carosi, Giampiero

doi: 10.1097/QAD.0b013e3282fbd1c4
Clinical Science

Objectives: To investigate the association between insulin resistance and rapid virologic response.

Design: All consecutive HIV/hepatitis C virus coinfected patients who started peg-interferon alpha-2a (180 μg/week) and ribavirin 1000–1200 mg/day were analysed.

Methods: Insulin resistance was defined according to the homeostasis model of assessment-insulin resistance calculated as fasting insulin (mIU/l) × fasting glucose (mmol/l)/22.5. Rapid virologic response was defined as testing negative for hepatitis C virus-RNA after 4 weeks of therapy. Fasting levels of insulin and glucose in plasma were measured in all patients on the first day of treatment. Hepatitis C virus-RNA was determined by quantitative PCR assay (version 3.0). Hepatitis C virus-RNA was measured by qualitative PCR assay (COBAS 2.0) after 4 weeks of treatment.

Results: Seventy-four HIV/hepatitis C virus coinfected patients were enrolled [mean age 41.7 years (SD 5.3), 61 men, 54.1% with advanced fibrosis (F3-4 according to METAVIR classification), 52.4% with infection by hepatitis C virus genotype 1 or 4]. Rapid virologic response was reached by 30 subjects. In the multivariate analysis the independent predictors of rapid virologic response were: genotype 1 or 4 [adjusted odds ratio 0.18 (0.06–0.55)], hepatitis C virus-RNA < 400.000 UI/ml [adjusted odds ratio 0.229 (0.09–0.92)] and homeostasis model of assessment-insulin resistance more than 3.00 [adjusted odds ratio 0.1 (0.05–0.6)].

Conclusion: The homeostasis model of assessment-insulin resistance score should be evaluated and possibly corrected before starting anti-hepatitis C virus therapy.

From the Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.

Correspondence to Paola Nasta, MD, Institute of Infectious and Tropical Diseases, University of Brescia, P. le Spedali Civili, 1, 25123 Brescia, Italy. Tel: +39 030 3995665; fax: +39 030 303061; e-mail: paola.nasta@tin.it

© 2008 Lippincott Williams & Wilkins, Inc.