Hepatitis & HIV

`Liver stiffness` and insulin resistance connection in HIV/hepatitis C coinfected patients

Michael Carter
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Spanish investigators have found that HIV/hepatitis C coinfected patients with insulin resistance have significantly higher liver stiffness scores. The study is further evidence of the association between insulin resistance and poorer outcome in coinfected patients, and was presented to the Fourth International Workshop on HIV and Hepatitis C Coinfection in Madrid on June 19th.

Tests to measure liver stiffness, such as FibroScan are painless, quick and acceptable to patients, and they are now widely used to monitor fibrosis in patients coinfected with HIV and viral hepatitis. There is increasing evidence that insulin resistance is associated with poorer outcomes in patients coinfected with HIV/hepatitis C and a multi-centre team of Spanish investigators wanted to see if there was any association between insulin resistance and fibrosis, as measured by liver stiffness.

For the purpose of the study, insulin resistance was defined as a homeostasis model assessment (HOMA) score of 2 or above, and significant fibrosis was assessed as being present if a patient had a liver stiffness score of 7.2 kPa (kilPascals) or higher.

Glossary

insulin

A hormone produced by the pancreas that helps regulate the amount of sugar (glucose) in the blood.

fibrosis

Thickening and scarring of connective tissue. Often refers to fibrosis of the liver, which can be caused by an inflammatory reaction to long-term hepatitis infection. See also ‘cirrhosis’, which is more severe scarring.

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

hepatitis B virus (HBV)

The hepatitis B virus can be spread through sexual contact, sharing of contaminated needles and syringes, needlestick injuries and during childbirth. Hepatitis B infection may be either short-lived and rapidly cleared in less than six months by the immune system (acute infection) or lifelong (chronic). The infection can lead to serious illnesses such as cirrhosis and liver cancer. A vaccine is available to prevent the infection.

statistical significance

Statistical tests are used to judge whether the results of a study could be due to chance and would not be confirmed if the study was repeated. If result is probably not due to chance, the results are ‘statistically significant’. 

A total of 111 patients from hospitals across Spain were included in the study. Most of these patients (79%) were male, 55% were infected with the hard to treat hepatitis C genotype 1, 4% were also infected with hepatitis B virus, and 90% were taking anti-HIV treatment.

A total of 49% of these patients had a liver stiffness score of 7.2 kPa with 33% having a score of 9 kPa or above.

Results showed that there was a statistically significant relationship between insulin resistance and liver stiffness, with 32% of patients with a HOMA score below 2 having a liver stiffness score of 7.2 kPa or above compared to 58% of patients with a HOMA score above this level (p = 0.02).

Multivariate analysis confirmed that association between insulin resistance and liver stiffness (p = 0.04). This analysis also showed that a CD4 cell count below 200 cells/mm3 (p = 0.02) and infection with hepatitis B virus (p = 0.04) were also associated with liver stiffness.

References

Merchante N. et al. Insulin resistance is associated with liver stiffness in HIV/HCV coinfected patients. Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 1, 2008.

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