Chronic hepatitis c genotype-4 infection: role of insulin resistance in hepatocellular carcinomaReportar como inadecuado

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Virology Journal

, 8:496

First Online: 01 November 2011Received: 06 July 2011Accepted: 01 November 2011


BackgroundHepatitis C virus HCV is a major cause of chronic hepatitis and hepatocellular carcinoma HCC and different HCV genotypes show characteristic variations in their pathological properties. Insulin resistance IR occurs early in HCV infection and may synergize with viral hepatitis in HCC development. Egypt has the highest reported rates of HCV infection predominantly genotype 4 in the world; this study investigated effects of HCV genotype-4 HCV-4 on prevalence of insulin resistance in chronic hepatitis C CHC and HCC in Egyptian patients.

MethodsFifty CHC patients, 50 HCC patients and 20 normal subjects were studied. IR was estimated using HOMA-IR index and HCV-4 load determined using real-time polymerase chain reaction. Hepatitis B virus was excluded by enzyme-linked immunosorbent assay. Standard laboratory and histopathological investigations were undertaken to characterize liver function and for grading and staging of CHC; HCC staging was undertaken using intraoperative samples.

ResultsHCC patients showed higher IR frequency but without significant difference from CHC 52% vs 40%, p = 0.23. Multivariate logistic regression analysis showed HOMA-IR index and International Normalization Ratio independently associated with fibrosis in CHC; in HCC, HbA1c, cholesterol and bilirubin were independently associated with fibrosis. Fasting insulin and cholesterol levels were independently associated with obesity in both CHC and HCC groups. Moderate and high viral load was associated with high HOMA-IR in CHC and HCC p < 0.001.

ConclusionsIR is induced by HCV-4 irrespective of severity of liver disease. IR starts early in infection and facilitates progression of hepatic fibrosis and HCC development.

Keywordshepatitis C HCV-4 insulin resistance fibrosis hepatocellular carcinoma Electronic supplementary materialThe online version of this article doi:10.1186-1743-422X-8-496 contains supplementary material, which is available to authorized users.

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Autor: Amal A Mohamed - Samah A Loutfy - James D Craik - Abdel Gawad M Hashem - Ibrahem Siam


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