Recent experimental and clinical studies have shown that
chronic hepatitis C virus (HCV)
infection causes
insulin resistance. Since
insulin resistance decreases response to
antiviral treatments, promotes inflammatory and fibrogenic reactions and increases a risk of
hepatocellular carcinoma (HCC), amelioration of
insulin resistance may be a novel therapeutic target, which could improve the prognosis in patients with HCV-related chronic
liver disease. Despite the increased awareness of health risk of
insulin resistance, there is no common therapeutic strategy for HCV-associated
insulin resistance. Indeed, treatments with exogenous
insulin or sulfonylureas may be rather harmful because these treatments are associated with the development of HCC in patients with HCV
infection. Meanwhile, we, along with others, have found distinctive treatments which improve HCV-associated
insulin resistance. Administration of
branched-chain amino acids (BCAA), especially as a late evening snack, improves
glucose metabolism by improving
insulin-signal cascades in
insulin resistance patients with HCV
infection. In this paper, we discuss the pathogenesis and complications for HCV-associated
insulin resistance and further review a recent clinical therapeutic strategy using these agents for the treatment of this devastating disorder. We also discuss therapeutic potentialities of
incretin-based
therapies, new anti-diabetic agents for HCV-associated
insulin resistance and the significance of
insulin resistance in the era of new anti-viral treatments.