To assess glucose tolerance and insulin sensitivity in viral hepatitis C (HCV) infection and their relationship with viral genotype, liver fibrosis and antiviral treatment.

We recruited 32 patients with positive ELISA serology for hepatitis C antibodies, fibrosis score obtained by liver biopsy or Fibrotest, and known viral strain through genotyping. For each patient, we performed a clinical examination to search for signs of insulin resistance, and a 120-minute 75-g oral glucose tolerance test. We also collected a fasting venous blood sample for the measurement of serum lipids. We performed on day 2 a short insulin tolerance test to measure insulin sensitivity.

Among the 32 patients hepatitis C virus was of genotype 1 in 17 patients, genotype 2 in 6 and genotype 4 in 9 patients. Eleven patients had no or mild fibrosis (F0-1), 11 had moderate fibrosis (F2), and 10 had severe fibrosis or cirrhosis (F3-4). Based on the OGTT, 47 % of the patients had impaired glucose tolerance, and 6 % had diabetes diagnosed for the first time. Insulin sensitivity was within normal range in 2/32 patients, all others having impaired insulin sensitivity. Viral genotypes 1 and 4 where associated with higher frequencies of glucose metabolism disorders : 58 % and 55 % of impaired glucose tolerance respectively. Insulin sensitivity expressed as KITT in %/min was however similar 1,79 ± 0,33 for genotype 1, 1,67 ± 0,12 for genotype 2, and 1,66 ± 0,09 for genotype 4. The frequency of abnormal glucose metabolism also increased with degree of liver fibrosis without statistical difference in insulin sensitivity. Treated patients had more frequent glucose intolerance than their non treated counterparts and were more insulin-resistant (p = 0,01), but this was not independent of the degree of fibrosis.

Our study shows an association between higher fibrosis scores, viral genotype 1 and 4 and insulin resistance and impaired glucose tolerance. Possible effect of antiviral treatment on glucose metabolism cannot be discriminated from the severity of liver fibrosis based on the limited number of patients studied.