Insulin resistance is independently associated with significant hepatic fibrosis in Asian chronic hepatitis C genotype 2 or 3 patients

Abstract

In this subgroup study of Asian-region HCV genotype 2 or 3 patients, insulin resistance, along with age, cholesterol levels and necro-inflammation, but not steatosis may be associated with significant hepatic fibrosis.

Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

“…Furthermore, the association of obesity with increased risk of concurrent NAFLD is well accepted, and it is reasonable to suspect that concurrent NAFLD among patients with chronic HCV infection leads to more severe hepatic steatosis, hepatic inflammation, and progression of fibrosis [26]. In our current study, six studies demonstrated a significant association between concurrent obesity and advanced fibrosis among patients with chronic HCV [3,5,6,[10][11][12]. This conclusion remained consistent even after correcting for the presence of concurrent DM or steatosis.…”

“…Obesity was defined as BMI C 30 kg/m 2 among Caucasians and BMI C 25 kg/m 2 among Asians. Combining both race groups together, the investigators observed a trend toward increased odds of fibrosis (OR 1.08; 95 % CI 1.00-1.17; p = 0.05) [12]. However, a subsequent study by Alsatie et al [13] that evaluated BMI C 36 kg/m 2 found no significant association with advanced fibrosis after adjustments in a multivariate model.…”

“…In particular, the effects of diabetes mellitus (DM), metabolic syndrome, and concurrent nonalcoholic fatty liver disease (NAFLD) have been implicated in the progression of hepatic fibrosis and cirrhosis [2]. However, the impact of the aforementioned factors on progression of disease among chronic HCV patients is complicated by conflicting results of existing studies [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Furthermore, the lack of consistency in defining certain risk factors (e.g., obesity, DM, insulin resistance) among published studies additionally complicates the ability to truly ascertain the impact of these comorbidities on HCV progression.…”

Comparative assessment of liver fibrosis in patients with HIV/chronic hepatitis C co-infection in different ethnic groups

“…In recent years, there has been increased interest in research related to the development of liver fibrosis in HIV/HCV co-infection in patients of specific racial/ethnic groups, which requires objective methods of assessment [24,25,45,46].…”

Fibrosis and fibrogenesis

“…In nonalcoholic steatohepatitis and HCV infection, hepatic insulin signaling is impaired and downregulation of insulin-sensitive targets is observed; this has been shown to be associated with apoptosis and fibrogenesis [7]. In an Asian study, hepatic fibrosis was also found to be associated with insulin resistance based on a homeostatic model assessment of insulin resistance in infections with HCV genotypes 2 and 3 [8]. In HCV infection, 25-hydroxyvitamin D blood levels are low and cytochrome P27A1, a liver 25-hydroxylating enzyme, correlates with 25-hydroxyvitamin D serum levels, which are said to be associated with liver fibrosis [9].…”