Insulin Dominantly Suppresses Hepatitis B Virus Gene Expression in Cultured Human Hepatoma Cells

Evaluation of the Relationship between Insulin Resistance and HBV DNA Level in Patients with HBeAg-negative Chronic HBV Infection (Natural Course Phase 3)

Background and aims

Chronic hepatitis B (CHB) infection is an important cause of morbidity and mortality worldwide with an increased risk of liver failure, cirrhosis, and hepatocellular carcinoma. Hepatitis B virus (HBV) DNA level, the marker of viral load in the host, is a parameter affected by host factors. In this study, we investigated the relationship between HBV DNA level and insulin resistance as a host factor.

Methods

In this study, 146 patients diagnosed with “HBeAg-negative chronic HBV infection” (natural course phase 3, inactive carrier) according to the European Association for the Study of the Liver (EASL) 2017 guidelines were retrospectively analyzed and demographic, anthropometric, histopathological, radiological and laboratory data of the patients were recorded. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) levels of the patients were calculated, and according to the value, the patients were divided into two groups as insulin resistant and non-insulin resistant. All parameters, including HBV DNA, were evaluated and compared between the two groups.

Results

77 patients (52.7%) were insulin resistant with a HOMA-IR value of 2.5 or more. The remaining 69 patients (47.3%) whose HOMA-IR value less than 2.5 were non-insulin resistant. The median HBV DNA was 410 IU in the insulin-resistant group and 350 IU in the other group, and there was no statistical significance between the two groups (p: 0.537). HBV DNA level was only positive correlated with HBsAg level and negatively correlated with anti-Hbs level and age (p < 0.005). Compared to the non-insulin resistant group, body mass index (BMI), presence of hepatosteatosis on ultrasonography (USG), fasting blood sugar, fasting insulin, total protein, gamma glutamyl transferase (GGT), triglyceride (TG), very-low-density lipoprotein (VLDL), uric acid level, triglyceride/high-density lipoprotein (HDL) ratio were significantly higher and HDL levels were significantly lower in the insulin-resistant group (p < 0.005). GGT levels and TG/HDL ratio were found to be higher in patients with hepatosteatosis on ultrasonography than in patients without hepatosteatosis (p < 0.005). TG/HDL ratio was found to be an independent factor in predicting insulin resistance and every 1 unit increase of this ratio increases the risk of developing insulin resistance 2.1 times.

Conclusion

In this study, no significant relationship was found between insulin resistance and HBV DNA levels in chronic inactive HBV carriers. In addition, insulin resistance was observed more frequently in these patients compared to the general population, and insulin resistance was found to be associated with high BMI, hepatosteatosis rate, VLDL, TG, GGT, total protein, uric acid, TG/HDL ratio, and low HDL. TG/HDL ratio was found to be successful in predicting insulin resistance.

How to cite this article

Senoymak MC, Ozkan H. Evaluation of the Relationship between Insulin Resistance and HBV DNA Level in Patients with HBeAg-negative Chronic HBV Infection (Natural Course Phase 3). Euroasian J Hepatogastroenterol 2020;10(2):85–91.

The risky body mass index ranges for significant hepatitis B viral load: A campus-based study

SUMMARY

Significant hepatitis B viral load (≥10,000 copies/mL) was established to increase risk of advanced liver diseases. The aim of this study was to explore the metabolic risk factors for significant hepatitis B viral load. A campus-based cohort consisting of 146 participants of chronic hepatitis B virus (HBV) infection in Northern Taiwan was investigated in 2009. Clinical profiles including serum levels of deoxyribonucleic acid of hepatitis B virus (HBV DNA) were collected. Hepatitis B e antigen (HBeAg) serostatus, high alanine aminotransferase level, body mass index (BMI) ranges, and insulin resistance were related to significant HBV DNA levels in univariate analysis. Compared to individuals with BMI 23-24.9 kg/m(2) in multivariate analysis, those with BMI ≥25 kg/m(2) (OR = 3.86, 95% CI = 1.38-10.8, P = 0.010) and those with BMI <23 kg/m(2) (OR = 4.47, 95% CI = 1.32-15.2, P = 0.016) were at higher risk for significant HBV DNA levels. This phenomenon was also manifest in HBeAg seronegatives, who contributed to a majority of significant viral load in our study. Furthermore, insulin resistance and BMI ≥25 kg/m(2) had positive additive effects on significant HBV DNA levels (adjusted OR = 9.34, 95% CI = 1.74-50.3, P = 0.009). In conclusion, having certain BMI ranges (BMI ≥25 kg/m(2) or BMI <23 kg/m(2)) could be a risk factor of significant HBV DNA levels.: