Diabetes type 2 mellitus (T2DM) is the most common extrahepatic association of hepatitis C virus (HCV) infection. Substantial research has suggested that insulin resistance (IR) has crucial importance in development of type 2 diabetes in HCV-infected patients. Several pathophysiological mechanisms are proposed, such as direct effect of HCV proteins on inhibition of the insulin-signaling pathway inducing central insulin resistance (IR), while overproduction of inflammatory cytokines and increased lipolysis promote peripheral IR. IR in HCV-infected patients is associated with impaired sustained virologic response (SVR) and higher incidence of hepatocellular carcinoma (HCC). Some, but not all, studies have shown improvements in achieving SVR in patients with interferon/ribavirin (RBV) therapy co-treated with metformin or pioglitazone as well as beneficiary effect on the incidence of hepatocellular carcinoma. Recent studies indicate that response to the new direct-acting antiviral (DAA) treatments is unaffected by insulin resistance thus diminishing importance of IR in the new era of DAA. Additionally, viral eradication by DAAs has been shown to ameliorate insulin resistance, attenuating the risk of new-onset diabetes type 2. However, those metabolic improvements are sustainable long after the treatment remains unclear.
Part of the book: Update on Hepatitis C
The complexity of the hepatitis C virus (HCV) infection is reflected in its therapy, and great efforts are needed from the patient and the physician to be successful in eliminating the infection. How HCV will progress depends a lot on patient characteristics and social factors, in addition to the timing of initiation, duration, and final results of the therapy. The first treatment approved for patients with chronic hepatitis C was interferon (IFN) which had a sustained viral response (SVR) rate in 20%. Due to side effects, the adherence to this treatment was limited and required a patient-tailored approach with various medical disciplines working together and intervening at the right time to minimize potential obstacles. The introduction of direct-acting antivirals (DAAs) has contributed to the advancement of HCV treatment. However, a major obstacle to wide use of DAAs is their high price which has largely limited access to treatment. Guidelines and recommendations on treatment of hepatitis C have been developed to assist physicians and other health care providers to determine priority. Despite that, the arrival of new oral therapies has been met with enthusiasm as shorter, simpler, safer treatment allows for the possibility of delivering antiviral therapy on a large scale.
Part of the book: Update on Hepatitis C
Obesity is a complex metabolic and behavioural disorder associated with increased health risk, including coronary artery disease, congestive heart failure and sudden cardiac death. Effective prevention and treatment strategies for obesity are needed. This unmet need for efficient and safe antiobesity medication resulted in many new therapies at various stages of development. Obesity has become one of the most intensively studied diseases because of the availability of suitable animal and cell culture models of adipocyte differentiation and appetite regulation.
Part of the book: Drug Discovery