Insulin resistance and liver fibrosis progression in patients with chronic hepatitis C virus infection

Background and study aimsHepatitis C virus (HCV) infection can predispose to development of insulin resistance before diabetes occurs. Such a potential link is particularly cogent in light of recent data indicating that diabetes might be associated with increased hepatic fibrosis progression in patients with chronic HCV infection. This study aims to determine the prevalence of insulin resistance in non-diabetic patients with chronic hepatitis C and its relation to liver fibrosis.Patients and methodsThis study included a cohort of 38 patients with chronic liver diseases. They were subdivided into two groups: chronic hepatitis C (CHC) with elevated liver enzymes and CHC with normal liver enzymes. Twelve age- and sex-matched healthy subjects were considered as the control group. The cohort was subjected to careful history and complete examination stressing upon the signs and symptoms of chronic liver diseases. Investigations include liver function tests, viral markers (anti-HCV antibodies and polymerase chain reaction (PCR) for HCV), serum fasting glucose, serum fasting insulin and homeostasis model assessment (HOMA), liver biopsy and abdominal ultrasound.ResultsLiver fibrosis was found to be considerably more severe among HCV patients with elevated serum transaminases levels. No correlation between viral load and hepatic fibrosis in HCV-infected patients was found. Insulin resistance was present in HCV-infected cases compared with the control group and it correlated with liver fibrosis positively.ConclusionThe present data support the hypothesis that insulin resistance may increase the rate of fibrosis progression in non-diabetic patients with chronic HCV. Follow-up of hyperinsulinaemia by serial measurement of HOMA test in non-diabetic HCV-infected patients may be a biochemical indicator for progression of liver fibrosis.