Importance of hepatitis C virus-associated insulin resistance: therapeutic strategies for insulin sensitization.

Abstract

Insulin resistance is one of the pathological features in patients with hepatitis C virus (HCV) infection. Generally, persistence of insulin resistance leads to an increase in the risk of life-threatening complications such as cardiovascular diseases. However, these complications are not major causes of death in patients with HCV-associated insulin resistance. Indeed, insulin resistance plays a crucial role in the development of various complications and events associated with HCV infection. Mounting evidence indicates that HCV-associated insulin resistance may cause (1) hepatic steatosis; (2) resistance to anti-viral treatment; (3) hepatic fibrosis and esophageal varices; (4) hepatocarcinogenesis and proliferation of hepatocellular carcinoma; and (5) extrahepatic manifestations. Thus, HCV-associated insulin resistance is a therapeutic target at any stage of HCV infection. Although the risk of insulin resistance in HCV-infected patients has been documented, therapeutic guidelines for preventing the distinctive complications of HCV-associated insulin resistance have not yet been established. In addition, mechanisms for the development of HCV-associated insulin resistance differ from lifestyle-associated insulin resistance. In order to ameliorate HCV-associated insulin resistance and its complications, the efficacy of the following interventions is discussed: a late evening snack, coffee consumption, dietary iron restriction, phlebotomy, and zinc supplements. Little is known regarding the effect of anti-diabetic agents on HCV infection, however, a possible association between use of exogenous insulin or a sulfonylurea agent and the development of HCC has recently been reported. On the other hand, insulin-sensitizing agents are reported to improve sustained virologic response rates. In this review, we summarize distinctive complications of, and therapeutic strategies for, HCV-associated insulin resistance. Furthermore, we discuss supplementation with branched-chain amino acids as a unique insulin-sensitizing strategy for patients with HCV-associated insulin resistance.

• Authors: Takumi Kawaguchi, Michio Sata
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 16 Issue 16 Pg. 1943-52 (Apr 28 2010) ISSN: 2219-2840 [Electronic] United States
• PMID: 20419831 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Antiviral Agents
• Insulin

Topics

• Antiviral Agents (pharmacology)
• Carcinoma, Hepatocellular (complications, virology)
• Cell Proliferation
• Esophageal and Gastric Varices (virology)
• Fatty Liver (pathology)
• Fibrosis (virology)
• Hepacivirus (metabolism)
• Hepatitis C (complications, immunology, virology)
• Humans
• Insulin (metabolism, therapeutic use)
• Insulin Resistance
• Life Style
• Liver (pathology)
• Liver Neoplasms (complications, virology)