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Original article

Insulin resistance impairs sustained virological response rate to pegylated interferon plus ribavirin in HIV–hepatitis C virus-coinfected patients: HOMAVIC-ANRS HC02 Study

Patrice Cacoub, Fabrice Carrat, Pierre Bédossa, Jérôme Lambert, Guillaume Pénaranda, Stanislas Pol, Philippe Halfon

Corresponding author name: Patrice Cacoub
Corresponding author e-mail: patrice.cacoub@psl.aphp.fr

Citation: Antiviral Therapy 2009; 14:839-845
doi: 10.3851/IMP1298

Date accepted: 31 May 2009
Date published online: 05 October 2009

Abstract

Background: The aim of this study was to assess the effect of insulin resistance (IR) on the response to hepatitis C virus (HCV) therapy in HIV–HCV-coinfected patients.

Methods: A total of 238 HIV–HCV-coinfected patients (74% male, mean ±sd age 40 ±5 years, mean alcohol intake <50 g/day and 38% HCV genotype 2 or 3), treated by standard or pegylated interferon-α2b plus ribavirin during 48 weeks were studied. Liver biopsies were assessed before treatment. Patients were considered to have IR when the homeostasis model assessment of IR (HOMA-IR) was >2.5. Multiple logistic regression with stepwise selection was used to estimate independent factors associated with sustained virological response (SVR).

Results: IR was present in 32% and significant liver fibrosis (MetavirF2) in 74% of patients. Patients with SVR (96/238 [40%]) were more likely to be infected with HCV genotype 2 or 3 (54% versus 27%; P<0.0001), and had more severe liver fibrosis (F3; 45% versus 30%; P=0.03). By multivariate analysis, a HOMA-IR>2.5 had a negative effect on the SVR (odds ratio 0.49 [95% confidence interval 0.26–0.92]; P=0.05).

Conclusions: A high HOMA-IR level is frequently found in HIV–HCV-coinfected patients and is associated with a reduced SVR rate. Improving insulin sensitivity might be a useful adjunct to HCV therapy in HIV–HCV-coinfected patients.

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