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Insulin resistance (IR) is a condition that is considered ‘pre-
diabetes.’ There has been speculation that insulin resistance may be
linked to HCV infection, but until now there has not been a great deal
of research to validate this theory. Now a study published in Gastroenterology titled “Insulin Resistance in Chronic Hepatitis C: Association with
Genotypes 1 and 4, Serum HCV RNA Level, and Liver,” by Moucaria, R and
colleagues, is providing some very compelling clinical data that the
hepatitis C virus may indeed cause insulin resistance in people with
chronic hepatitis C genotype 1 and 4.
- Metabolic syndrome is defined as a cluster of conditions – excess weight, high
triglycerides (fats), low levels of HDL or good cholesterol, high blood
pressure and high blood glucose or sugar levels in the blood.
- Insulin resistance is a condition where blood cells are not able to adequately process
glucose or blood sugars. Increased glucose in the blood will give a
signal to the pancreas that it needs to release more insulin, which
then leads to high levels of insulin and glucose in the bloodstream.
In their prospective study, 600 consecutive unselected patients with
either chronic hepatitis B (100 patients) or chronic hepatitis C (500
patients) were enrolled. All the participants were evaluated for
insulin resistance, and metabolic syndrome before undergoing a liver
biopsy to stage and grade liver damage.
What the authors found was insulin resistance in 32.4% of the 462
non-diabetic chronic hepatitis C patients, and IR was associated with
metabolic syndrome, significant fibrosis, or severe steatosis. Fifteen
percent of the 145 chronic hepatitis C participants without metabolic
syndrome or significant fibrosis were diagnosed with insulin
resistance, and the diagnosis of insulin resistance was associated with
HCV genotype 1 and 4, high serum HCV RNA (viral load) level, and
moderate-to-severe necroinflammation (cell inflammation and death).
Fifty-one percent the 454 non-cirrhotic chronic hepatitis C
participants were found to have significant fibrosis and this was
associated with male sex, age greater than 40 years old, insulin
resistance, moderate-to-severe necroinflammation, and severe
steatosis. The degree or severity of fibrosis was also found to be
associated with insulin resistance even without steatosis.
It was also found that the overall incidence of insulin resistance was
dramatically lower in the chronic hepatitis B group (5%) compared to
the chronic hepatitis C group (35%).
The
authors noted that, given the high numbers of insulin resistance in
their study, routine management of hepatitis C should include an
assessment of insulin resistance.
Reference
Moucaria, R, et al. Insulin Resistance in Chronic Hepatitis C:
Association with Genotype 1 and 4, Serum RNA Level, and Liver Fibrosis,
Gastroenterology Vol. 134, Issue 2, Pages 415-423 (February 2008)
http://www.hcvadvocate.org/news/newsLetter/2008/advocate0508.html#5
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