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IMPACT OF HIGH SERUM GLUCOSE ON LIVER FIBROSIS
IN CHRONIC HEPATITIS C
Reported by Jules Levin
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We know that persons with HIV are experiencing higher rates of diabetes,
glucose abnormalities, and other metabolic abnormalities. In Hepatitis C,
elevated glucose and diabetes are associated. A French research group
including Thierry Poynard reported at this year's DDW conference on the
association between high glucose and liver disease fibrosis. 710 patients
with chronic hepatitis C and no HIV or HBV coinfection were retrospectively
studied. 55% of patients had no or minimal fibrosis (Metavir F0 or F1) and
45% had septal fibrosis (F2, F3 or F4). Independent risk factors of septal
fibrosis were: age (p<10-3), daily alcohol (p<10-3), serum glucose (p=0.003),
anti-HBc (p=0.04) and male sex (p=0.04). BMI (p<10-3; r=0.26), serum
triglycerides (p=0.002; r=0.12), serum ferritin (p<10-3; r=0.18) and
steatosis (p<10-3; r=0.16), were associated with serum glucose but did not
independently predict septal fibrosis.
After adjustment for the duration of infection, patients with serum glucose
>6.1 mmol/l had a faster progression to septal fibrosis than those with
normal serum glucose (p<10-3 by log rank test). Multivariate analysis by the
Cox model showed that age at infection >30 yrs. (p<10-3), male sex (p<10-3),
daily alcohol >50 g (p=0.02) and serum glucose >6.1 mmol/l (p<0.05) were
independently associated with septal fibrosis.
A separate, per fibrosis stage showed that serum glucose >6.1 mmol/l was
associated with intermediate (F3) and advanced (F4) but not with early (F2)
fibrosis stages. The authors concluded that in patients with chronic
hepatitis C, high serum glucose independently predicts liver fibrosis and
might explain some of the individual variability in fibrosis progression.
High serum glucose might play a role in intermediate and advanced rather than
early fibrogenesis and best accounts for the fibrogenic effect of overweight
and related metabolic complications.
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