- [Show abstract] [Hide abstract] ABSTRACT: Metabolic syndrome is recognised as a potential risk factor for the development of hepatocellular carcinoma (HCC). The association between metabolic factors and hepatitis C (HCV)-related HCC has not yet been well clarified. This study was conducted to elucidate the role of metabolic factors in HCV-related HCC. We recruited 147 HCC patients and compared them with 147 matched CHC patients and 320 controls. The plasma levels of homeostasis model assessment-IR (HOMA-IR), adiponectin and lipids for all participants were assessed. The HCC group showed significantly higher levels of insulin, glucose, HOMA-IR and adiponectin as well as lower levels of total cholesterol, HDL-C, LDL-C, and triglycerides compared with the matched CHC patients and controls. HOMA-IR did not correlate with pathologic features of HCC, whereas serum adiponectin levels correlated positively with the size of tumour nodules (P = 0.009). Based on stepwise logistic regression analysis, age (OR: 1.456, 95% CI: 1.072-1.979, P < 0.01), HOMA-IR (OR: 2.50, 95% CI: 1.70-3.69, P = 0.001), and adiponectin (OR: 1.585, 95% CI: 1.269-1.980, P = 0.001) were independently associated with HCC. Metabolic abnormalities are closely associated with the occurrence and development of HCV-related HCC. Patients with CHC and high serum adiponectin levels face a higher risk of developing liver cancer. Insulin resistance, as measured by HOMA-IR, is significantly associated with HCV-related HCC.
- [Show abstract] [Hide abstract] ABSTRACT: Hepatitis C virus (HCV) infection, especially genotypes 1 and 4, is associated with wide metabolic disarrangements. To assess whether host metabolic factors influence sustained virological response (SVR) in patients with chronic hepatitis C genotype 4 (HCV-4) treated with peginterferon / ribavirin and to evaluate the impact of antiviral therapy on insulin resistance (IR) and serum levels of adipocytokines. Changes in levels of adiponectin, leptin, TNF-α and the homeostasis model assessment for insulin resistance (HOMA-IR) on antiviral combination in patients with HCV-4 were analyzed and effect on response was studied. 107 patients were included (M/F 86/21; mean age 41.4±5.6 years). Neither serum adipocytokines nor HOMA-IR was correlated with viral load. SVR was achieved by 57% of patients and was associated with fibrosis score (odds ratio: 6.5; P = 0.001) and adiponectin level (odds ratio: 1.3; P = 0.01). At the end of follow-up, HOMA-IR, adiponectin, leptin and TNF-α were reduced, all these changes unrelated to predicting the outcome of treatment. At follow-up, HOMA-IR and adiponectin continued to decrease in patients with SVR, but remained unchanged significantly in patients who did not response or relapse. Serum adiponectin at baseline appears to be an independent predictor for the achievement of SVR and can be utilized as an additional predictive marker. Changes of IR and adipocytokines occur under treatment which is more evident with the resolution of HCV infection, suggesting that HCV could have a direct role in these metabolic changes.
- [Show abstract] [Hide abstract] ABSTRACT: Metabolic abnormalities are common in chronic hepatitis C infection (CHC). However, the genotypic differences of these disarrangements in patients infected with CHC genotype 4 (HCV-4) and its association with liver histology and viral loads remain unknown. We consecutively enrolled 183 HCV-4 patients and 106 healthy matched controls; to compare metabolic profiles and assess pattern of association of HCV RNA levels as well as histological factors with the serum lipid profile. HCV-4 infection is associated with higher homeostasis model assessment of insulin resistance (HOMA-IR) index, despite that, a favourable lipid pattern, consisting of an elevation in HDL- C and a reduction in serum cholesterol (TC), LDL-C and triglyceride (TG) levels, in comparison with normal matched adults. Significant fibrosis was independently associated with HOMA-IR, portal/periportal inflammation grade, serum cholesterol and age. Univariate association was elucidated between lower LDL-C and TC and Metavir activity score and between higher TG and TC and steatosis. In multivariate analysis, severe hepatitis activity, milder hepatic fibrosis, and triglyceride levels are associated with higher HCV RNA levels. HCV-4 is associated with wide metabolic changes. A proportional relationship is found between serum lipid profiles and hepatitis C viral load and liver histology in patients with HCV-4.