Safely restarting GI endoscopy in the era of COVID-19

Abstract

<h3>Background:</h3> The factors that influence liver fibrosis progression in patients co-infected with human immunodeficiency virus/hepatitis C virus (HIV/HCV) are not completely understood. It is not known if insulin resistance (IR), a condition that promotes liver fibrosis in HCV mono-infected individuals, is one of these factors. <h3>Objective:</h3> To evaluate the association between IR and liver stiffness (LS). <h3>Design:</h3> Multicentre cross-sectional study. <h3>Patients:</h3> 330 patients co-infected with HIV/HCV. <h3>Methods:</h3> LS was assessed by transient elastography, which has shown a high accuracy to predict significant fibrosis in patients co-infected with HIV/HCV. The outcome variable of the study was LS. Patients with LS⩾9 kPa were considered as having significant fibrosis. IR was calculated using the HOMA method. <h3>Results:</h3> LS was ⩾9 kPa in 150 (45%) patients. HOMA correlated with LS (Spearman’s rho correlation coefficient, 0.37; p&lt;0.0001). The median (Q1–Q3) HOMA in patients with LS⩾9 kPa was 3.30 (2.17–5.16) while it was 2.09 (1.37–3.22) in patients with LS &lt;9 kPa (p&lt;0.0001). Ninety-six (39%) individuals with a HOMA &lt;4 and 54 (63%) with a HOMA ⩾4 showed LS⩾9 kPa (p&lt;0.0001). Analyses after excluding patients with cirrhosis yielded similar results. After multivariate analyses, age ⩾40 years (adjusted odds ratio (AOR), 1.85; 95% confidence interval (CI), 1.03 to 3.29; p = 0.03), CD4 cell count &lt;200 cells/ml (AOR, 3.45; 95% CI, 1.67 to 7.11; p = 0.001), hepatitis B virus co-infection (AOR, 9.25; 95% CI, 2.42 to 35.31; p = 0.001), and HOMA ⩾4 (AOR, 5.33; 95% CI, 2.70 to 10.49; p&lt;0.0001) were the independent predictors of LS⩾9 kPa. <h3>Conclusion:</h3> IR is associated with LS in patients co-infected with HIV/HCV.