الفهرس 
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Abstract
Background & Aim: Hepatitis C virus (HCV) infection, especially genotypes 1 and 4, is associated with wide metabolic disarrangements. This study aimed to assess whether host metabolic factors influence sustained virological response (SVR) in patients with chronic hepatitis C genotype 4 (HCV-4) treated with peginterferon /ribavirin and to evaluate the impact of anti-viral therapy on insulin resistance (IR) and serum levels of adipocytokines.
Methods: Changes in levels of adiponectin, leptin, TNF-α and the homeostasis model assessment for insulin resistance (HOMA-IR) on antiviral combination in patients with HCV-4 were analyzed and effect on response was studied in 107 HCV-4 patients and 89 healthy control .
Results: 107 patients were included (M/F 86/21; mean age 41.4±5.6 years). Neither serum adipocytokines nor HOMA-IR was correlated with viral load. SVR was achieved by 57% of patients and was associated with fibrosis (odds ratio: 6.5; P = 0.001), HOMA-IR (odds ratio: 8.046; P = 0.001), and adiponectin level (odds ratio: 1.3; P = 0.01). At the end of follow-up; HOMA-IR, adiponectin, leptin and TNF-α were reduced, all these changes unrelated to predicting the outcome of treatment. At follow-up, HOMA-IR and adiponectin continued to decrease in patients with SVR, but remained unchanged significantly in patients who did not response or relapsed.
Overall, 61 patients achieved an SVR (57%). We examined the baseline disease and demographic characteristics of the patients in the study according to SVR status. subjects who achieved an SVR were significantly younger, had lower HOMA-IR scores, less viral load, less fibrosis, lower leptin levels, higher HDL-C and higher adiponectin levels compared with non-SVRs. There was no association between gender ,BMI ,ALT value , cholesterol , portal periportal activity ,or steatosis and in relation to SVR. When the data were analayzed by multivariate logistic egression , our results suggested that fibrosis (odds ratio :6.5 , P value 0.001) and basal adiponectin level (odds ratio :1.3 , P value 0.01) were independent factors associated with SVR in genotype 4 CHC patients treated with Peg- IFN plus RBV. There was no association between gender, BMI, alanine aminotransferase value, cholesterol, portal / periportal activity, or steatosis and in relation to SVR. When the data were analyzed by multivariate logistic regression, our results suggested that Non-severe fibrosis (METAVIR score F0–F2) (odds ratio: 6.5; P = 0.001), HOMA-IR score (odds ratio: 8.046; P = 0.001), and adiponectin level (odds ratio: 1.3; P = 0.01) were independent factors associated with SVR in genotype 4 CHC patients treated with Peg-IFN plus RBV.