Relationship between hepatitis C virus (HCV) and insulin resistance, endothelial perturbation, and platelet activation in HIV-HCV-coinfected patients under highly active antiretroviral treatment

• Published in: European journal of clinical microbiology & infectious diseases Vol. 25; no. 2; pp. 98 - 103
• Main Authors: DE LARRANAGA, G. F, PERES WINGEYER, S. D. A, PUGA, L. M, ALONSO, B. S, BENETUCCI, J. A
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-02-2006; Springer Nature B.V
• Subjects: Adhesion; Adult; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Biological and medical sciences; CD4 Lymphocyte Count; Cross-Sectional Studies; Female; Hepatitis; Hepatitis C - complications; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - pathology; HIV Infections - physiopathology; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Insulin resistance; Insulin Resistance - physiology; Male; Medical sciences; Multivariate Analysis; P-Selectin - blood; Platelet Activation - drug effects; Platelet Activation - physiology; Risk factors; Vascular Cell Adhesion Molecule-1 - blood; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral hepatitis; Viral Load; von Willebrand Factor - metabolism; Immunopathology; Mixed infection; Microbiology; Hepatic disease; AIDS; Immune deficiency; Insulin; Infection; Virus; Target tissue resistance; Chemotherapy; Platelet; Treatment; Viral disease; Digestive diseases; Antiviral; Flaviviridae; Hepatitis C virus; Hepacivirus; Viral hepatitis C
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-006-0090-6

Insulin resistance is associated with highly active antiretroviral therapy in HIV-infected patients, and the risk of developing insulin resistance is increased in hepatitis C virus (HCV)-infected patients. The aim of the present study was to determine whether hepatitis C virus infection constitutes an additional risk factor for insulin resistance or other prothrombotic conditions in HIV-HCV coinfected patients under highly active antiretroviral therapy. One hundred eighteen HIV-infected patients were studied: 50 who had no history of anti-HIV treatment and 68 who were receiving therapy with highly active antiretroviral treatment. The treatment-naive group consisted of 35 HCV-negative subjects and 15 HCV-positive ones. Within the treated group, 50 patients were HCV negative and 18 were HCV positive. For each patient, the lipid profile was determined and the following values measured: glucose, soluble P-selectin (as a marker of platelet activation), soluble thrombomodulin, von Willebrand factor and soluble vascular cell adhesion molecule-1 (as endothelial markers), and insulin resistance. No significant difference (p>0.05) for any variable was found among subjects with or without HCV coinfection in the treatment-naïve group. Among patients under highly active antiretroviral therapy, however, those with HCV coinfection showed higher values (p<0.05) for insulin resistance (homeostasis model assessment value: 2.65 vs. 1.79), glucose (93 vs. 86 mg/dl), endothelial markers (von Willebrand factor, 204 vs. 123%; soluble vascular cell adhesion molecule-1, 650 vs. 482 ng/ml), and platelet activation marker (soluble P-selectin, 78 vs. 51 ng/ml) in parallel with lower CD4+ cells counts (289 vs. 402 cells/mm3) and higher HIV-1 viral loads (305 vs. 50 copies/ml) compared to patients without HCV coinfection. Glucose, soluble P-selectin, and von Willebrand factor were independently related to HCV infection. The presence of HCV coinfection during HIV treatment was closely related to higher values of insulin resistance, to activated platelets, and to endothelial perturbation in parallel with lower CD4+ cell counts and higher HIV-1 viral loads compared to patients without HCV coinfection. On the basis of these results, it may be preferable to treat HCV infection prior to initiating treatment for HIV infection in HIV-HCV-coinfected patients.