Triglycerides,LDL cholesterol and HOMA score predict the virological response in HIV/HCV co-infected patients

1. Triglycerides,LDL cholesterol and HOMA score predict the virological response in HIV/HCV co-infected patients treated with Pegylated interferon alpha 2a and Ribavirn Paola Nasta MD Institute of Infectious and Tropical Diseases University of Brescia P.Le Spedali Civili, 1 25123 Brescia, ITALY Tel +39-030-3995665 E-mail: paola.nasta@tin.it P.Nasta MD; F. Gatti MD, G. Cologni MD, A. Matti MD, M. Mendeni MD, L. Biasi MD, M. Puoti Prof and G. Carosi Prof. Institute of Infectious and Tropical Diseases, University of Brescia, Italy Results Background Variables correlated with Rapid (RVR), Early (EVR) and Sustained (SVR) virologic response • HCV positive persons had an increase risk for type 2 diabetes mellitus particularly • if cirrhotic (Knobler H et al. Mayo Clin Proc; 2000) and when older than 40 years • (Mehta SH et al. Ann Intern Med; 2000) • In HIV-HCV co-infected patients, insulin resistance is caused by • both HCV infection and HAART therapy particularly when based on • protease inhibitors (Braitstein P et al. AIDS; 2004) and thymidine analogues • (Martin A et al. J Antimicrob and Chemoter; 2005) • In HIV/HCV co-infected subjects, insulin resistance and LDL cholesterol • are emerging as important host factors in the prediction of response in • non diabetic patients treated with PEG-IFN plus ribavirin • (Nasta P. et al, AIDS 2008; del Valle J et al. AIDS 2008) Aim and Methods • HIV-HCV co-infected patients who started pegylated interferon alfa-2a • (180 mcg/week) and Ribavirin1000-1200 mg/die(14 mg/kg(day) from January 2005 • have been enrolled. • At fasting insulin, glucose, total cholesterol, LDL (Low Density Lipoprotein), • HDL (High Density Lipoprotein) and triglycerides (TGD) plasma level were measured • in all patients on the first day of treatment with PegIFN/RBV and every three months • HOMA-IR (HOMA: HOmeostasis Model of Assessment ) has been • calculated as fasting insulin (mIU/L) × fasting glucose (mmol/L) ÷ 22.5; • (normal range 0,7-2,25). • HCV-RNA was measured by quantitative PCR assay (Versant 3.0) at baseline • and HCV-RNA by qualitative PCR assay (COBAS 2.0) after 4 weeks of treatment • and every three months. • Patients with at least 3 months of anti HCV treatment entered in the analysis. • Association between lipid and glucose parameters and RVR (Rapid Virologic Response), • EVR (Early Virological Response) and SVR (Sustained Virological Response ) • has been assessed CONCLUSIONS • Metabolic parameters as insulin resistance (HOMA >3), Low Density Lipoproteins (LDL) and • triglycerides are predictive factors for rapid, early and sustained virologic response in HIV/HCV co-infected patients treated with PegIFN/RBV • Insulin resistance (HOMA-IR>3) represents the key metabolic factor in lipid and glucose metabolism impairment • related with HCV and HIV/HAART. HOMA-IR >3 impairs RVR,EVR and SVR. • LDL cholesterol level is usually lower in patients with viral hepatitis, in particular sustained by genotypes 2-3. • Higher LDL level improves rapid virologic response in HV/HCV co-infected patients treated with PegIFN/RBV • High level of triglycerides could be related with booth insulin resistance and antiretrovirals lypodistrophic effect. • Hypertriglyceridemia represents a negative predictor in rapid and early virologic response in HIV/HCV co-infected • subjects. • Metabolic parameters have to be analysed and adjusted before to start treatment with PegIFN/RBV in HIV/HCV • co- incfection. Descriptive statistics are calculated for all the variables, data are expressed as number and percentage or mean (+SD) and median (IQR). All statistical analyses will be conducted at the alpha = 0.05 level and will be two-tailed. Baseline Variables in patients with or without RVR,EVR and SVR were compared using the Chi square test and Fisher’s exact test Variables possibly associated with RVR;EVR, SVR achievement were evaluated using the logistic regression model. Analyses were performed using Epi InfoTM version 3.3.2 (February 9,2005)