Insulin Resistance and Diabetes Increase Fibrosis in the Liver of Patients With Genotype 1 HCV Infection

Petta, Salvatore; Cammà, Calogero; Marco, V. Di; Alessi, Nicola; Cabibi, Daniela; Caldarella, Rosalia; Licata, Anna; Massenti, Fatima Maria; Tarantino, Giuseppe; Marchesini, Giulio; Craxı̀, Antonio

doi:10.1111/j.1572-0241.2008.01813.x

Cited by 165 publications

(153 citation statements)

References 48 publications

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“…Animal models also provide clues regarding the prevention and clinical management of diabetes in the setting of HCV infection [108] . Indeed, identifying patients who are at risk of developing diabetes, and have CHC, reduces liver disturbance progression [267,268] , the incidence of HCC and transplant-related morbidity and mortality. Additionally, this identification improves the response to antiviral therapy [269][270][271] , even reducing the side effects of the treatment [270] by encouraging the pretreatment of IR and DM [265] .…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

Antonelli

Ferrari

Giuggioli

et al. 2014

WJD

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cytokines, chemokines, and other immune-mediated mechanisms. Few data have been reported on the association of CHC and T1DM and reports on the potential association between T1DM and acute HCV infection are even rarer. A small number of studies indicate that interferon-α therapy can stimulate pancreatic autoimmunity and in certain cases lead to the development of T1DM. Diabetes and CHC have important interactions. Diabetic CHC patients have an increased risk of developing cirrhosis and hepatocellular carcinoma compared with non-diabetic CHC subjects. However, clinical trials on HCV-positive patients have reported improvements in glucose metabolism after antiviral treatment. Further studies are needed to improve prevention policies and to foster adequate and cost-effective programmes for the surveillance and treatment of diabetic CHC patients. AbstractHepatitis C virus (HCV) infection and diabetes mellitus are two major public health problems that cause devastating health and financial burdens worldwide. Diabetes can be classified into two major types: type 1 diabetes mellitus (T1DM) and T2DM. T2DM is a common endocrine disorder that encompasses multifactorial mechanisms, and T1DM is an immunologically mediated disease. Many epidemiological studies have shown an association between T2DM and chronic hepatitis C (CHC) infection. The processes through which CHC is associated with T2DM seem to involve direct viral effects, insulin resistance, proinflammatory Submit a

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Section: Prevention and Treatmentmentioning

confidence: 99%

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

Antonelli

Ferrari

Giuggioli

et al. 2014

WJD

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“…Previous studies have shown that DM not only accelerates the histological progression of chronic hepatitis C but also impairs the treatment response to IFN-based therapy. 17,[20][21][22] In addition, it has also been suggested that DM is associated with a higher risk of HCC development in patients with chronic hepatitis C compared to hepatitis B virus (HBV)-infected subjects or those without HBV and HCV infections. [23][24][25][26] However, this finding has not always been supported by other reports.…”

mentioning

confidence: 99%

Impact of diabetes mellitus on incidence of hepatocellular carcinoma in chronic hepatitis C patients treated with interferon‐based antiviral therapy

Hung

Lee

Wang

et al. 2010

Intl Journal of Cancer

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There is strong evidence linking chronic hepatitis C virus (HCV) infection and Type 2 diabetes mellitus (DM). Recent studies have suggested that DM is associated with increased risk of developing hepatocellular carcinoma (HCC). The aim of our cohort study was to assess whether DM influence the incidence of HCC in chronic hepatitis C patients treated with interferon (IFN)-based antiviral therapy. A total of 1,470 chronic hepatitis C patients treated with IFN or pegylated-IFN plus ribavirin therapy were enrolled. Of them, 253 (17%) patients had DM at entry. Evaluation of HCC incidence was performed by Kaplan-Meier method and Cox proportional hazards analysis. Patients with baseline DM were significantly older and had higher body mass index, serum transaminase levels and fibrosis scores and lower platelet counts compared to non-DM subjects. Sustained virological response (SVR) was achieved in 160 (63%) of DM and 867 (71%) of non-DM patients (p 5 0.008). During a median follow-up period of 4.3 years, HCC developed in 21 (8.3%) of DM and 66 (5.4%) of non-DM patients (p 5 0.017). However, DM was not an independent covariate by Cox proportional hazards analysis. In a subgroup analysis, DM (hazard ratio, 4.32; 95% confidence interval, 1.23-15.25; p 5 0.023) was an independent predictor of HCC in the SVR patients without baseline cirrhosis, despite a low HCC incidence. In conclusion, DM has a selective impact on HCC development among chronic hepatitis C patients after IFN-based therapy. DM may increase the HCC risk in chronic hepatitis C without cirrhosis after eradication of HCV.

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“…Insulin resistance (IR) is exceedingly common in patients with hepatitis C virus (HCV)-related chronic liver disease, 32 and both experimental 33 and clinical studies 34 suggested that HCV per se is able to decrease insulin sensitivity. IR has been systematically associated with advanced fibrosis and fibrosis progression in several reports.…”

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confidence: 99%

Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis

et al. 2008

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P ortal hypertension (PH), defined by a hepatic venous pressure gradient (HVPG) greater than 6 mmHg, 1 is a common complication of cirrhosis. The presence and the development of esophageal varices (EV) is a clinical manifestation of PH, 2,3 with a prevalence that can range from 40% to 80% in patients with cirrhosis. This prevalence increases progressively in relation to the severity of liver damage. 4,5 The presence of EV is also a clear indicator of a certain stage of cirrhosis. 6 The development of EV in patients with cirrhosis occurs when the HVPG is greater than 10 mmHg, 3,7 with an incidence of approximately 5% per year and a yearly rate of progression to larger varices of 5% to 15%. 4,5,8 The clinical relevance of EV is linked to the risk of bleeding that occurs when HVPG is greater than 12 mmHg, 7-9 with a mortality rate that exceeds 20% within 6 weeks from the bleeding episode, despite aggressive treatment. 10 The Baveno IV 2005 Consensus Workshop 11 and the American Association for the Study of Liver Diseases 2007 single-topic symposium on portal hypertension 12 recommended that endoscopic screening for esophageal and gastric varices should always be performed when a diagnosis of cirrhosis is made. Upper endoscopy should be repeated at 2-year to 3-year intervals in patients without varices, and at 1-year to 2-year intervals in those with small varices, to evaluate their development or progression. 11,12 These guidelines might not be ideal for clinical

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Insulin Resistance and Diabetes Increase Fibrosis in the Liver of Patients With Genotype 1 HCV Infection

Abstract: In subjects with CHC resulting from G1-HCV, IR and overt diabetes are major determinants of advanced fibrosis, regardless of the degree of steatosis, mainly in the presence of severe necroinflammation.

Cited by 165 publications

References 48 publications

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

Impact of diabetes mellitus on incidence of hepatocellular carcinoma in chronic hepatitis C patients treated with interferon‐based antiviral therapy

Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis

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