Observational Study
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World J Hepatol. Sep 27, 2014; 6(9): 677-684
Published online Sep 27, 2014. doi: 10.4254/wjh.v6.i9.677
Insulin resistance and steatosis in HBV-HCV co-infected patients: Role of PNPLA3 polymorphisms and impact on liver fibrosis progression
Rosa Zampino, Nicola Coppola, Grazia Cirillo, Adriana Boemio, Carmine Minichini, Aldo Marrone, Maria Stanzione, Mario Starace, Emanuele Durante-Mangoni, Evangelista Sagnelli, Luciano Restivo, Giovanna Salzillo, Maria Chiara Fascione, Riccardo Nevola, Emanuele Miraglia del Giudice, Luigi Elio Adinolfi
Rosa Zampino, Adriana Boemio, Aldo Marrone, Luciano Restivo, Maria Chiara Fascione, Riccardo Nevola, Luigi Elio Adinolfi, Department of Medical, Surgical, Neurological, Metabolic, and GeriatricSciences, Second University of Naples, 80100 Naples, Italy
Nicola Coppola, Carmine Minichini, Mario Starace, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80100 Naples, Italy
Grazia Cirillo, Emanuele Miraglia del Giudice, Department of Pediatrics, Second University of Naples, 80100 Naples, Italy
Maria Stanzione, Department of Clinical and Experimental Medicine and Surgery, “F. Magrassi e A. Lanzara”, Second University of Naples, 80100 Naples, Italy
Emanuele Durante-Mangoni, Internal Medicine Monaldi Hospital, Second University of 80100 Naples, Italy
Luciano Restivo, Giovanna Salzillo, Luigi Elio Adinolfi, Clinical Hospital of Marcianise, ASL Caserta, 81025 Marcianise (CE), Italy
Author contributions: Zampino R and Coppola N conceived and drafted the manuscript; Cirillo G, Boemio A, Minichini C, Starace M and Salzillo G carried out laboratory work; Marrone A, Stanzione M, Durante-Mangoni E, Restivo L and Fascione MC co-operated in patients enrollment; Sagnelli E and del Giudice EM critically reviewed the manuscript; Adinolfi LE conceived, draft and critically reviewed the manuscript; all authors approved the final version of the manuscript.
Supported by Regione Campania, Italy
Correspondence to: Luigi Elio Adinolfi, MD, Professor, Clinical Hospital of Marcianise, ASL Caserta, Rione Santella, 81025 Marcianise (CE), Italy. luigielio.adinolfi@unina2.it
Telephone: +39-0823-690642 Fax: +39-0823-690642
Received: May 11, 2014
Revised: July 8, 2014
Accepted: August 27, 2014
Published online: September 27, 2014
Abstract

AIM: To evaluate steatosis, insulin resistance (IR) and patatin-like phospholipase domain-containing 3 (PNPLA3) and their relation to disease progression in hepatitis B and C viruses (HCV-HBV) co-infected patients.

METHODS: Three hundred and thirty patients with biopsy proven chronic hepatitis were enrolled: 66 had HBV-HCV, 66 HBV and 198 HCV infection. Prevalence of steatosis, IR and PNPLA3 polymorphisms and their relation to anthropometric, biochemical, virological and histological parameters were evaluated.

RESULTS: Prevalence of steatosis in group HBV-HCV was similar to that in HCV (47.0% vs 49.5%, respectively); group HBV showed the lowest steatosis (33.3%). Group HBV-HCV had a lesser degree of steatosis than HCV (P = 0.016), lower HCV RNA levels (P = 0.025) and lower prevalence and degree of IR (P = 0.01). PNPLA3 polymorphisms were associated with steatosis. Group HBV-HCV showed higher levels of liver fibrosis than group HCV (P = 0.001), but similar to that observed in HBV group. In HBV-HCV group, liver fibrosis was not associated with steatosis, IR or PNPLA3. HBV infection was the independent predictor of advanced liver fibrosis.

CONCLUSION: HBV-HCV co-infected patients have lower degree of hepatic steatosis, IR and HCV RNA than HCV mono-infected; co-infected patients showed a more rapid liver fibrosis progression that seems to be due to the double infection and/or HBV dominance.

Keywords: Steatosis, Insulin resistance, Hepatitis B and C viruses co-infection, Patatin-like phospholipase domain-containing 3, Liver fibrosis

Core tip: We evaluated the prevalence and role of steatosis, insulin resistance and patatin-like phospholipase domain-containing 3 (PNPLA3) polymorphisms on disease progression in hepatitis B and C viruses (HCV-HBV) co-infected patients. The data showed that HBV-HCV patients have lower levels of liver steatosis and insulin resistance than HCV mono-infected patients. HBV seems to interact with HCV reducing HCV replication and HCV-related metabolic features. Thus, the influence of HCV-related steatosis and insulin resistance as well as PNPLA3 polymorphism do not significantly impact liver fibrosis progression in HBV-HCV patients. The more rapid progression of liver fibrosis observed in HBV-HCV co-infected patients seems to be mostly associated with HBV infection.