{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T11:25:12Z","timestamp":1745666712189,"version":"3.37.3"},"reference-count":33,"publisher":"FapUNIFESP (SciELO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"abstract":"<jats:p>ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is a serious public health problem, that affects approximately 170 million people worldwide. Chronic HCV infection is associated with hepatic insulin resistance and an increased risk of diabetes HCV-infected patients has been well documented. OBJECTIVE: To assess the homeostasis model assessment of insulin resistance (HOMA-IR) index in patients treated with direct acting antiviral (DAAs) medication in the sustained virological response (SVR), categorized by the presence or absence of cirrhosis. METHODS: A prospective study was conducted. Data were collected at the beginning of treatment (t-base) and in the twelfth week after the completion of treatment (t-SVR12). The inclusion criteria were presence of: HCV infection (RNA-HCV positive), age \u226518 years, completion of DAAs\u2019 therapy, and presence of diabetes with use of oral hypoglycemic agents. All samples were collected during the study period. The exclusion criteria were: presence of HBV\/HIV co-infection, hepatocellular carcinoma at baseline, diabetic patients taking insulin and transplanted patients (liver\/kidney). Fibrosis was assessed by hepatic elastography or biopsy (METAVIR). Cirrhosis was determined by clinical results or imaging. HOMA-IR was calculated as fasting insulin (\u03bcU\/mL) \u00d7 fasting glucose (mmol\/L)\/22.5) The patients were divided into two groups: the general study population (all patients, including the diabetic patients) and the special population (patients with normal values of HOMA-IR, which is &gt;2.5, and without diabetes). The delta HOMA-IR value was calculated as: HOMA-IR at t-base - HOMA-IR at t-SVR12. For the descriptive statistical analysis, the paired t-test and generalized linear model assuming the log binding function were performed. A P value of &lt; 0.05 was considered significant. RESULTS: We included 150 patients, and 75 were cirrhotic. The mean age was 55.3\u00b19.97 and body mass index was 27.4\u00b15.18. Twenty-two (14.67%) were diabetic patients using oral hypoglycemic agents, and 17 (11%) were cirrhotic. In the general study population, the mean glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. Delta HOMA-IR was negative at t-SVR12, but there was no significant difference. Excluding diabetic patients and those with normal HOMA-IR values (&lt;2.5), mean glucose, insulin and HOMA-IR decreased at t-SVR12. Delta HOMA-IR decreased significantly at t-SVR12 (P: 0.02). CONCLUSION: In the general population, glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. In the special population, glucose, insulin, HOMA-IR and Delta HOMA-IR decreased at t-SVR12.<\/jats:p>","DOI":"10.1590\/s0004-2803.201800000-69","type":"journal-article","created":{"date-parts":[[2018,12,15]],"date-time":"2018-12-15T13:33:42Z","timestamp":1544880822000},"page":"274-278","source":"Crossref","is-referenced-by-count":9,"title":["INSULIN RESISTANCE REDUCTION AFTER SUSTAINED VIROLOGICAL RESPONSE WITH DIRECT ACTING ANTIVIRAL:NOT EVERY POPULATION IMPROVES"],"prefix":"10.1590","volume":"55","author":[{"given":"Vanessa Gutierrez de","family":"ANDRADE","sequence":"first","affiliation":[{"name":"Universidade Estadual Paulista, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F\u00e1bio da Silva","family":"YAMASHIRO","sequence":"additional","affiliation":[{"name":"Universidade Estadual Paulista, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e1ssio Vieira","family":"OLIVEIRA","sequence":"additional","affiliation":[{"name":"Universidade Estadual Paulista, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alecsandro","family":"MOREIRA","sequence":"additional","affiliation":[{"name":"Universidade Estadual Paulista, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Cristina","family":"WINCKLER","sequence":"additional","affiliation":[{"name":"Universidade Estadual Paulista, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6129-7045","authenticated-orcid":false,"given":"Giovanni Faria","family":"SILVA","sequence":"additional","affiliation":[{"name":"Universidade Estadual Paulista, 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F","year":"2010","journal-title":"Gut"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-2000-9506","article-title":"Epidemiology of hepatitis C: geographic differences and temporal trends","volume":"20","author":"Wasley A","year":"2000","journal-title":"Semin Liver Dis"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1002\/hep.1840120409","article-title":"Interrelationship of blood transfusion, non A, non B hepatitis and hepatocellular carcinoma: analysis by detection of antibody to hepatitis C virus","volume":"12","author":"Kiyosawa K","year":"1990","journal-title":"Hepatology"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-2000-9505","article-title":"Recovery, persistence, and sequelae in hepatitis C virus infection: A perspective on longterm outcome","volume":"20","author":"Alter HJ","year":"2000","journal-title":"Semin Liver Dis"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jare.2016.11.003","article-title":"Current level of evidence on causal association between hepatitis C virus and type 2 diabetes: a review","volume":"8","author":"Gastaldi G","year":"2017","journal-title":"J Adv Res"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S0168-8278(05)80631-2","article-title":"Evidence for a link between hepatitis C v\u00edrus infection and diabetes mellitus in a cirrhotic population","volume":"21","author":"Allison ME","year":"1994","journal-title":"J Hepatol"},{"key":"ref9","first-page":"544","article-title":"Prevalence of diabetes mellitus in patients with chronic hepatitis C: a case-control study","volume":"20","author":"Grimbert S","year":"1996","journal-title":"Gastroenterol Clin Biol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"355","DOI":"10.4065\/75.4.355","article-title":"A increased risk of type 2 diabetes in noncirrhotic patients with chronic hepatitis C virus infection","volume":"75","author":"Knobler H","year":"2000","journal-title":"Mayo Clin Proc"},{"key":"ref11","first-page":"178","article-title":"Insulin resistance in chronic hepatitis C","volume":"44","author":"Parise ER","year":"2007","journal-title":"Arq Gastroenterol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1053\/j.gastro.2003.08.032","article-title":"Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression","volume":"125","author":"Hui JM","year":"2003","journal-title":"Gastroenterology"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0168-8278(01)00143-X","article-title":"Risk factors for diabetes mellitus and early insulin resistance in chronic hepatitis C","volume":"35","author":"Petit JM","year":"2001","journal-title":"J Hepatol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/S0168-8278(03)00463-X","article-title":"In overweight patients with chronic hepatitis C, circulating insulin is associated with hepatic fibrosis: implications for therapy","volume":"39","author":"Hickman IJ","year":"2003","journal-title":"J Hepatol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1136\/gut.2010.213553","article-title":"Components of metabolic syndrome are independent predictors of mortality in patients with chronic liver disease: a population-based study","volume":"59","author":"Stepanova M","year":"2010","journal-title":"Gut"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1002\/hep.26437","article-title":"Homeostasis model assessment of insulin resistance does not seem to predict response to telaprevir in chronic hepatitis C in the REALIZE trial","volume":"58","author":"Younossi Z","year":"2013","journal-title":"Hepatology"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1053\/j.gastro.2004.12.049","article-title":"Insulin Resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients","volume":"128","author":"Romero-Gomez M","year":"2005","journal-title":"Gastroenterology"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1111\/jvh.12567","article-title":"Sofosbuvir plus simeprevir for the treatment of HCV genotype 4 patients with advanced fibrosis or compensated cirrhosis is highly efficacious in real life","volume":"23","author":"Willemse SB","year":"2016","journal-title":"J Viral Hepat"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"567e571","DOI":"10.1016\/j.kjms.2017.07.003","article-title":"The outcomes of glucose abnormalities in chronic hepatitis C patients receiving interferon-free direct antiviral agents","volume":"33","author":"Huang JF","year":"2017","journal-title":"Kaohsiung J Med Sci"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"7075","DOI":"10.3748\/wjg.v12.i44.7075","article-title":"Insulin resistance and hepatitis C","volume":"12","author":"Romero-Gomez M","year":"2006","journal-title":"World J Gastroenterol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1002\/hep.510240201","article-title":"An algorithm for the grading of activity in chronic hepatitis C","volume":"24","author":"Bedossa P","year":"1996","journal-title":"Hepatology"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2337\/diacare.23.1.57","article-title":"Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity","volume":"23","author":"Bonora E","year":"2000","journal-title":"Diabetes 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BJ","year":"2009","journal-title":"Am J Transplant"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/j.1365-2893.2011.01474.x","article-title":"Use of HOMA-IR in hepatitis C","volume":"18","author":"Eslam M","year":"2011","journal-title":"J Viral Hepat"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/j.jhep.2009.07.008","article-title":"Insulin resistance predicts rapid virological response in non-diabetic, non-cirrhotic genotype 1 HCV patients treated with peginterferon alpha-2b plus ribavirin","volume":"51","author":"Grasso A","year":"2009","journal-title":"J Hepatol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejim.2014.12.001","article-title":"Prevalence of steatosis and insulin resistance in patients with chronic hepatitis B compared with chronic hepatitis C and non-alcoholic fatty liver disease","volume":"26","author":"Pais R","year":"2015","journal-title":"Eur J Intern 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