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Insulin Resistance Predicts Rapid Response in People With HCV and HIV
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Mark Mascolini
February 28, 2007
14th Conference on Retroviruses and Opportunistic Infections
Los Angeles
Insulin resistance cut chances of a rapid virologic response (RVR) to treatment for HCV infection in people coinfected with HIV, according to results of a 56-person study at the University of Brescia in Italy.[1]. Protease inhibitor (PI) therapy, which may contribute to insulin resistance, had a smaller negative impact on chances of achieving an RVR.
Paola Nasta and Brescia colleagues measured insulin resistance by the HOMA-IR method in HCV/HIV-coinfected people starting 180 mcg of peglylated interferon alfa-2A weekly plus 1000 to 1200 of ribavirin daily. Everyone had received earlier anti-HCV therapy for at least 3 months.
Defining RVR as negative HCV-RNA by qualitative PCR 4 weeks after starting interferon/ribavirin, Nasta counted 22 people (39%) with a rapid response. Rapid responders were significantly less likely to have a HOMA-IR score above 3 (27%) than below 3 (73%) (P = 0.011) and significantly more likely to have a pretreatment HCV load below 400,000 IU/mL (59% versus 41% above 400,000 IU/mL) (P = 0.003).
Multivariate analysis determined that a HOMA-IR above 3 lowered the odds of RVR 86% (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 to 0.64, P = 0.011). A pretreatment HCV reading below 400,000 IU/mL more than quadruped the chance of achieving an RVR (OR 4.63, 95% CI 1.09 to 19.6, P = 0.037). Infection with HCV genotype 1 or 4, versus genotype 2 or 3, sliced the odds of having an RVR almost 90% (OR 0.11, 95% CI 0.02 to 0.4, P = 0.003).
Whereas 11 of 22 people (50%) who attained an RVR were taking a PI regimen, 27 of 34 people without an RVR (79%) were taking a PI (P = 0.02). But in a multivariate analysis PI-based therapy did not independently predict failure to achieve an RVR. Still, Nasta and coworkers believe a non-PI regimen "could be an option" to increase sensitivity to anti-HCV therapy in coinfected people.
The Brescia researchers note that insulin resistance is a prime predictor of response to interferon/ribavirin in nondiabetic people infected with HCV but not HIV. They believe their findings support HOMA-IR as a predictor of RVR in coinfected individuals.
Reference
1. Nasta P, Puoti M, Gatti F, et al. HOMA-IR is a strong predictor of rapid virologic response in HIV/HCV-co-infected patients treated with pegylated
interferon-alpha 2a and ribavirin. 14th Conference on Retroviruses and Opportunistic Infections. February 25-28, 2007. Los Angeles. Abstract 896.
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