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

• Main Authors: Keyur Patel, Alexander J. Thompson, Wan Long Chuang, Chuan Mo Lee, Chen Yuan Peng, Ganesananthan Shanmuganathan, Satawat Thongsawat, Tawesak Tanwandee, Varocha Mahachai, Chutima Pramoolsinsap, Mong Cho, Kwang Hyup Han, Samir R. Shah, Graham R. Foster, Paul J. Clark, Erik Pulkstenis, G. Mani Subramanian, John G. Mchutchison
• Format: Journal
• Published: 2018
• Subjects: Medicine
• Online Access: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=79958783189&origin=inward; http://cmuir.cmu.ac.th/jspui/handle/6653943832/50313
• Institution: Chiang Mai University

Background and Aim: The role of insulin resistance (IR) and hepatic steatosis in fibrogenesis in chronic hepatitis C infection (CHC) has yielded conflicting data and few studies have been performed in Asian-region populations. We retrospectively investigated the relationship between host metabolic variables, including IR and hepatic steatosis, to hepatic fibrosis in Asian-region CHC genotype 2/3 patients. Methods: A total of 303 treatment-naïve Asian-region patients with CHC genotype 2/3 were enrolled in a multicenter phase 3 study of albinterferon alfa-2b plus ribavirin for 24weeks. IR was defined as Homeostasis Model for Assessment of IR (HOMA-IR)>2. Baseline liver biopsy was evaluated by a single expert histopathologist. Post hoc subgroup logistic regression modeling selected for independent variables associated with significant fibrosis (METAVIR stage F2-F4). Results: Insulin resistance was available in 263 non-diabetic Asian-region patients (hepatitis C virus-2 [HCV-2]=171, HCV-3=92), and 433 non-Asian region patients (407 "Caucasian"); METAVIR fibrosis prevalence F0-F1 (minimal fibrosis)=201 (77%) and F2-F4 (significant fibrosis)=59 (23%), and steatosis prevalence of grade 0=169 (65%), grade 1=64 (25%), grade 2/3=27 (10%). Median HOMA-IR was 1.8 (interquartile range: 1.2-2.7); 100 (38%) patients had HOMA-IR>2. Factors independently associated with significant fibrosis included HOMA-IR (odds ratio [OR]=8.42), necro-inflammatory grade (OR=3.17), age (OR=1.07) and serum total cholesterol levels (OR=0.008). This was similar to non-Asian region patients, but steatosis was not associated with significant fibrosis in either cohort. Conclusions: 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. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.