Association Between Insulin Resistance and Hepatitis C Virus Chronic Infection in HIV–Hepatitis C Virus–Coinfected Patients Undergoing Antiretroviral Therapy

Abstract

Insulin resistance (IR) in the context of highly active antiretroviral therapy (HAART) is becoming more common in HIV-infected patients. Patients with chronic hepatitis C virus (HCV) infection have an increased risk of IR and type 2 diabetes mellitus. A cross-sectional study was performed to investigate whether chronic HCV infection constitutes a risk factor for IR in HIV-HCV-coinfected patients undergoing HAART. Inclusion criteria were positive HCV viremia and a sustained increase of alanine aminotransferase of at least twice the normal value. A total of 29 HIV-HCV patients, 76 HIV patients, and 121 HCV controls were tested for IR and body mass index (BMI). IR was measured using the homeostasis model assessment. In HIV-HCV and HIV patients, fat redistribution and lipid profile were assessed. There was no significant difference in age, CD4 cell count, HIV viral load, or duration of HAART between the HIV-HCV and HIV groups. HIV-HCV patients and HCV controls had a significant increase in IR when compared with HIV patients (0.25 +/- 0.28 and 0.21 +/- 0.34 versus 0.04 +/- 0.37; p =.01 and p =.003, respectively). Lipoatrophy was observed more frequently in HIV-HCV patients in comparison with HIV patients (41% versus 14%; p =.003). In HIV-HCV patients, total cholesterol and triglyceride levels were significantly lower than in HIV patients. In multivariate analysis, IR, BMI, triglyceride levels, and peripheral fat wasting were the independent variables associated with HCV infection. Our findings suggest that chronic HCV infection is a significant factor associated with the development of metabolic abnormalities and with modifications in body composition in HIV patients receiving antiretroviral treatment.

Association of hepatitis C virus infection and diabetes in central Tunisia

“…Therefore, we cannot establish the diabetic population as a group at high risk for HCV infection. Our findings did not confirm other studies that have reported increased HCV seroprevalence in patients with diabetes [10,[22][23][24][25][26] . In a case-control study conducted in the USA, 4.2% of 594 patients in a cohort with diabetes were found to be infected with HCV compared with 1.6% of control patients (377 patients with thyroid diseases) [27] .…”

Lipodystrophy in HIV 1-infected patients: lessons for obesity research

“…In this sense, partial lipoatrophy has been described in association with hepatitis B infection, 78 and coinfection with the hepatitis C virus favors lipoatrophy and metabolic disturbances in HIV 1-infected patients. 79,80 The concept that adipose tissue biology may be susceptible to viral infections has been extensively examined in relation to the role that human adenovirus-36 and perhaps other adenoviruses may have in promoting obesity. 81,82 Adenovirus-36 increases adipocyte differentiation of 3T3-L1 cells and human adipocytes, 83,84 and antibodies against adenovirus-36 are high in obese patients, 81 and thus it has been proposed that such viral infection may play an important role in the development of obesity.…”

Hepatitis C is associated with type 2 diabetes mellitus in HIV‐infected persons without traditional risk factors

“…However, other studies have suggested that HCV may be directly involved in the development of type 2 DM or insulin resistance even in those without cirrhosis [8,[17][18][19] 491 HCV-infected persons over the age of 40 years in a nationwide cross-sectional study [11] and then in a longitudinal cohort study found that those with HCV infection were at increased risk for developing DM with increasing age and body mass index (BMI). Another nationwide crosssectional study dividing patients into young and old groups found an association of HCV and DM in those who were younger and had a family history of DM [20].…”