Association between insulin resistance and hepatitis C virus chronic infection in HIV-hepatitis C virus-coinfected patients undergoing antiretroviraltherapy

Insulin resistance (IR) in the context of highly active antiretroviral ther apy (HAART) is becoming more common in HIV-infected patients. Patients with chronic hepatitis C virus (HCV) infection have an increased risk of IR and type 2 diabetes mellitus. A cross-sectional study was performed to investi gate whether chronic HCV infection constitutes a risk factor for IR in HIV- HCV-coinfected patients undergoing HAART. Inclusion criteria were positive HCV viremia and a sustained increase of alanine aminotransferase of at leas t twice the normal value. A total of 29 HIV-HCV patients, 76 HIV patients, and 121 HCV controls were tested for IR and body mass index (BMI). IR was m easured using the homeostasis model assessment. In HIV-HCV and HIV patients , fat redistribution and lipid profile were assessed. There was no signific ant difference in age, CD4 cell count, HIV viral load, or duration of HAART between the HIV-HCV and HIV groups. HIV-HCV patients and HCV controls had a significant increase in IR when compared with HIV patients (0.25 +/- 0.28 and 0.21 +/- 0.34 versus 0.04 +/- 0.37; p = .01 and p = .003, respectively ). Lipoatrophy uas observed more frequently in HIV-HCV patients in comparis on with HIV patients (41%; versus 14%: p = .003). In HIV-HCV patients, tota l cholesterol and triglyceride levels were significantly lower than in HIV patients. In multivariate analysis, IR, BMI, triglyceride levels, and perip heral fat wasting were the independent variables associated with HCV infect ion. Our findings suggest that chronic HCV infection is a significant facto r associated with the development of metabolic abnormalities and with modif ications in body composition in HIV patients receiving antiretroviral treat ment.