Insulin resistance is associated with progression to hepatic fibrosis in a cohort of HIV/hepatitis C virus-coinfected patients

Abstract

Overall, 56% had baseline HOMA-IR of at least 2. In the adjusted multivariate logistic analysis, only baseline BMI of more than 25 kg/m2 remained associated with insulin resistance [adjusted odds ratio 3.66, 95% confidence interval (CI) 1.70-7.92]. Rates of progression to significant hepatic fibrosis (APRI ≥ 1.5) were higher in those with HOMA-IR of at least 2 (16.32 per 100 person-years, 95% CI 6.68-25.97) compared with those with HOMA-IR less than 2 (7.95 per 100 person-years, 95% CI 0.16-15.75). Baseline HOMA-IR of at least 2 was associated with the development of significant fibrosis (adjusted hazard ratio 7.71, 95% CI 2.55-23.36).

Regression of liver stiffness after sustained hepatitis C virus (HCV) virological responses among HIV/HCV-coinfected patients

“…Although alcohol is a known cofactor for fibrosis progression in HIV/HCV-coinfected patients [23], and complete abstinence has been shown to improve survival [24], little is known about the impact of complete abstinence on fibrosis. Insulin resistance is another cofactor for hepatic fibrosis progression in HIV/HCVcoinfected patients [25] and is also associated with an increased risk of hepatocellular carcinoma [26]. However, severe insulin resistance was not associated with a lower likelihood of liver stiffness regression in our study.…”

“…F4 (>3.25) to F3/F2 (<3.25 and !1. 25) or less]. All analyses were adjusted for age, sex, pretreatment FIB4 values, and alcohol consumption.…”

Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy

“…Alternatively, HCV co-infection may be associated with CKD by increasing the prevalence of traditional CKD risk factors. In HIV-infected populations, co-infection has been associated with insulin resistance [51] and increases in carotid intima-media thickness and atherosclerosis [52], early markers for diabetes and cardiovascular disease, respectively. Lastly, as with HIV, there is evidence that persistent HCV replication can result in systematic inflammation and immune activation leading to endothelial dysfunction, which is prevalent in patients with severe renal failure [53, 54].…”

Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis

“…However, our analyses were controlled for antiretroviral use, and time updated CD4 cell count and HIV virologic control in addition to alcohol and drug use, which might be more common in our population. Finally, we could not assess the role of hepatic steatosis and insulin resistance, both important predictors of fibrosis progression [34, 35]. As marijuana use has been associated with the presence of steatosis, failure to account for steatosis would likely have biased our results away from the null rather than masking an effect of marijuana on fibrosis progression.…”