INSULIN RESISTANCE

The Role of HCV in the Development of Insulin Resistance

The Role of HCV in the Development of Insulin Resistance

Introduction

Hepatitis C is a serious liver disease caused by hepatitis C virus (HCV). HCV is spread primarily through contact with infected blood. It directly attacks the liver, which can cause liver damage and sometimes death. Hepatitis C was formerly known as hepatitis non-A non-B. Hepatitis C is spread primarily through contact with the blood of infected persons. It is spread by:

Sharing needles, intravenous drug and paraphernalia for injecting drugs;

The use of razors, tattoo needles or piercing instruments contaminated;

Blood transfusion, blood products or hemodialysis;

Occupational exposure to blood from an infected person;

Sexual contact (vaginal, anal or oral) with an infected person;

Pregnancy and / or childbirth (mother to child).

It is estimated that the risk of infection through sexual or perinatal transmission is much lower for HCV than HBV. There is no evidence that HCV is transmitted through breast milk. Right now, there is no indication that there transmission of hepatitis C within the family (without exposure to blood transmission, sexual and perinatal recognized), unlike hepatitis B. All people with hepatitis C are potentially infectious, they have symptoms or not (Taubes, 2011, p. 8).

Chronic infection by the hepatitis C virus (HCV) is a major cause of progressive liver injury leading to long-term progression to cirrhosis and hepatocellular carcinoma. However, the rate of histologic progression of these lesions is variable among patients and depends on the presence or absence of certain cofactors, such as age, male gender, an ethyl abusive consumption, iron accumulation, or a co-infection by the human immunodeficiency virus or hepatitis B. For ten years, increasing interest has focused around the metabolic syndrome, especially in insulin resistance, a central pathogenetic factor for this condition. This interest is not only related to the current epidemic of overweight / obesity, and therefore the chances of interaction between metabolic syndrome and hepatitis C, but also the fact that hepatitis C has shown to be capable of interacting directly with the signaling pathway of insulin in hepatocytes. This insulin resistance caused by a virus will not only add to that may be associated with concomitant metabolic syndrome, sometimes accelerating its move towards Type II diabetes, but also has two major effects on the liver disease. In fact, whatever its pathogenesis, insulin resistance during chronic hepatitis C contributes to the progression to cirrhosis and reduces the chances of response to antiviral therapy. In this article we will discuss the literature on the subject, with particular emphasis on the impact on the management of patients with chronic hepatitis C.

The insulin resistance: IR

The IR can be defined as a condition where the normal concentration of insulin does not ensure physiological metabolic functions. In this case, a higher concentration of insulin than normal is required to produce its effects. The character of the IR depends on the complex interaction between genetic factors (poorly known at present) and environmental factors (nutritional factors, lifestyle), the most important being obesity, particularly the visceral ...