Sustained virological response following chronic hepatitis C treatment is associated with improvement in insulin resistance

Background Insulin resistance ( IR ) is a key factor in the development of hepatic steatosis and fibrosis in chronic hepatitis C virus infection. Little is known about the impact of viral clearance on IR . Aim The aim of this study was to determine the impact of viral clearance on IR . Methods Eighty‐six patients treated according to standard clinical practice at an A ustralian teaching hospital between 2003 and 2007 were prospectively studied. Demographic, biochemical and histological data were collected. Results The mean pretreatment homeostatic model assessment– IR ( HOMA‐IR ) was similar in the sustained virological response ( SVR ) and non‐ SVR groups (2.7 ± 0.5 and 2.8 ± 0.4, respectively), and both values were consistent with significant IR . There was a significant improvement in HOMA‐IR (from 3.0 ± 1.0 to 2.2 ± 0.5, P = 0.04) at the end of treatment in the SVR group only. This trended towards significance at 6 months post‐treatment. Multiple regression analysis found improvement in both gamma‐glutamyl transpeptidase and alanine aminotransferase predicted improvement in HOMA‐IR when controlled for other potential factors ( P = 0.01). Conclusions Hepatitis C virus clearance is associated with improvement in IR . Although baseline hepatic fibrosis is a predictor of IR , changes in IR appear to be independent of changes in liver fibrosis. Treatment‐related improvement in gamma‐glutamyl transpeptidase and alanine aminotransferase seen with improved IR may be a possible marker of reduction of hepatic oxidative stress.