BACKGROUND: Hepatitis C virus (HCV) infection, especially genotype 1b is associated with wide metabolic disarrangements, leads to poor response to antiviral therapy. Insulin resistance (IR) is one of the predictors of sustained virological response (SVR) on peginterferon plus ribavirin therapy, however, there are few report on adiponectin. We evaluated the impact of antiviral therapy on serum level of adiponectin and IR, and whether host metabolic factors influence SVR in genotype 1b patients. METHODS: Overall, 92 HCV genotype 1binfected, treatment-naive patients (M/F 39/53; mean age 60.6+8.4 years) received 48-72 weeks of combination therapy with peginterferon and ribavirin depending on on-treatment response criteria. Individual characteristics (gender, age and body mass index), liver function tests (AST, ALT, -GTP and ZTT), host metabolic factors (fasting glucose, triglyceride, insulin and adiponectin), serum HCV RNA load, and liver fibrosis score were analyzed. Changes in levels of adiponectin and the homoeostatic model assessment for insulin resistance (HOMAIR) on virological response to peginterferon plus ribavirin therapy at pretreatment and 24 weeks after treatment were compared. Clinical factors, including the SNP rs8099917 near IL28B gene, were also analyzed the association with response to combination therapy for HCV. RESULTS: Baseline HOMA-IR <2.5 and >2.5 was seen in 63% and 37% of patients, respectively. The low level of baseline adiponectin <7.8 (male) and <13.5 (female) was observed in 18/39 (46.1%) and 22/53 (41.5%) of patients, respectively. However, neither serum adiponectin nor HOMA-IR was correlated with viral load. Rapid viral response (RVR) rates at week 4 viral load decline were significantly influenced by baseline HOMA-IR and adiponectin. SVR was achieved by 43/92 (47%) of patients and was associated with fibrosis score (odds ratio: 3.5; P <.05) and baseline serum adiponectin level (odds ratio: 1.3; P <.05), and IL28B genotype (odds ratio: 8.2; P <.01) by multivariate analysis. At the end of follow-up, HOMA-IR and serum adiponectin were significantly improved in patients with SVR, but remained unchanged significantly in patients who did not response or relapse. CONCLUSION: Serum adiponectin at baseline appears to be an independent predictor for the achievement of SVR and can be utilized as an additional predictive marker. Improvement of HOMA-IR and adiponectin occur under treatment which is more evident with the resolution of HCV infection, suggesting that metabolic factors and insulin resistance have a important role on peginterferon plus ribavirin treatment efficacy.
Watanabe, H., Saito, T., Katsumi, T., Tomita, K., Sato, C., Ishii, R., … Kawata, S. (2012). Pegylated interferon plus ribavirin therapy is associated with improvement of the serum adiponectin and insulin resistance in patients with genotype 1b chronic hepatitis C. Hepatology, 56, 1017A. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=70943350