Z Gastroenterol 2010; 48 - A42
DOI: 10.1055/s-0030-1254780

Early prediction for the success of the antiviral therapy by using HOMA index in chronic hepatitis C patients

B Lombay 1 F Szalay 2,
  • 1Szent Ferenc Hospital, Department of Internal Medicine, Miskolc
  • 2Semmelweis University, I. Clinic of Internal Medicine, Budapest

Background: The response to pegylated interferon (PEG-IFN) and ribavirin (RBV) treatment in chronic hepatitis C (CHC) is influenced by numerous factors. High baseline HOMA index, viral or metabolic insulin resistance (IR) or type 2 diabetes mellitus, hepatic steatosis and abnormal ALT on week 12 are associated with poor results.

Aim: To analyze the association between these parameters and the success of the antiviral treatment.

Patients and Methods: 116, treatment naïve CHC patients (46 male, M/70 female, F; all pts. genotype 1) were involved into the study. The mean age 47.6±4.7 (18–65) years, mean body weight 73.6±14.6kg; BMI (body mass index) 26.3±2.8; waist circumference 94.7±10.6cm (M); 86.8±11.8cm (F) was. 24 patients had type 2 diabetes mellitus. Body weight, BMI, waist circumference, HOMA (homeostasis assessment model) index, serum glucose, insulin and ALT levels were measured before (under) the treatment. Liver biopsy was performed in 93 patients. Liver steatosis proven by histology was also considered. We compared these parameters in both groups of responder and non-responder patients.

Results: The mean HOMA index was high (5.4+/2.3). Overall sustained viral response (SVR) rate was 40% (M: 33%, F: 46%). In patients with >2.0 HOMA the SVR rate was only 32% (28/88) than in pts. <2.0: 68% (19/28; p<0.01). Absence of hepatic steatosis was a good SVR prediction (18/25, 72%) vs. it's presence (17/68, 25%; p<0.01). SVR rate among the diabetic patients was only 17% (4/24) vs. non-diabetic patients (47%, 43/92; p<0.01). Abnormal ALT on week 12 was a strong negative SVR predictor (7/51, 14%) vs. normal ALT (40/65, 61%; p<0.01).

Conclusion: Viral or metabolic IR (characterized by high HOMA), type 2 diabetes mellitus, hepatic steatosis and abnormal ALT at week 12 are the best negative host predictors of the sustained virological response beyond the virological factors (genotype, viral load). Prospective, large patient number studies are required to evaluate the accurate role of the IR in the SVR in CHC patients.