Abstract
Background: Previous evidences support to inflammatory process associated with the IR those important factors in the development of fibrosis and hepatic damage in patients with HCV infection. Objectives: Determine the presence of immunological or histological differentces between hyperinsulinemic and non-hyperinsulinemic chronic HCV-infected patients with at least 10 years of evolution. Material and Methods: The body mass index, Child-Puigh score, liver function tests, and biochemical profile were evaluated in 30 control, 40 chronic HCV-infected patients with hyperinsulinemia, and in 40 normoinsulinemic chronic HCV-infected patients with at least 10 years of evolution. In addition, HCV genotype and viral load were established with the Amplicor System. In addition, nitrites in plasma, and TNF-α, IL-1β, TGF-β, IL-6, and insulin levels were determined. Results: No differences were found in BMI, Child-Pugh “A” scores, ALT, viral load, or genotype between the hyperinsulinemic (>25 IU/ml) and normoinsulinemic ( Hyperinsulinemia patients had a higher HOMA- IR value (13.6) than normoinsulinemia patients (3.4), and none had a glycemia > 126 mg/dl. Cy- tokines concentration did not show differences with respect to controls. Nitrites showed a slight increase only in patients with HCV infection. Conclusions: Absence of changes in the proinflammatory cytokines concentration or in some inflammation markers in chronic HCV patients with hyperinsulinemia suggests that long-term insulin levels, in presence of HCV, cannot explain by themselves the hepatic alterations observed in the patient with HCV infection, the presence of others elements (alcoholism, cirrhosis, etc.) is necessary to onset hepatic damage in these patients.
Highlights
Liver fibrosis, inflammation, pro-inflammatory or prothrombotic state, antiviral treatment failure, obesity, as well as insulin resistance (IR) have been observed in hepatitis C virus (HCV)-infected patients [1]
Other factors associated with fibrosis progression in the HCV patient are older age, consumption of alcohol, viral coinfections, and duration of infection
It is relevant to mention that metabolic markers, such as insulin resistance or type 2 diabetes, have been considered lately as other important factors involved in the progression of hepatic damage [15], suggesting that progression of hepatic damage in patients with HCV infection can be a consequence of insulin resistance ratherthan the viral infection per se [16]
Summary
Inflammation, pro-inflammatory or prothrombotic state, antiviral treatment failure, obesity, as well as insulin resistance (IR) have been observed in hepatitis C virus (HCV)-infected patients [1]. Insulin resistance has been linked with the presence of high levels of mRNA of genotypes 1 and 4 of HCV [6] For this reason, the association between IR severities with high viral load has been suggested. Previous evidences support to inflammatory process associated with the IR those important factors in the development of fibrosis and hepatic damage in patients with HCV infection. Conclusions: Absence of changes in the proinflammatory cytokines concentration or in some inflammation markers in chronic HCV patients with hyperinsulinemia suggests that long-term insulin levels, in presence of HCV, cannot explain by themselves the hepatic alterations observed in the patient with HCV infection, the presence of others elements (alcoholism, cirrhosis, etc.) is necessary to onset hepatic damage in these patients
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