Résumé
Chronic HCV infection is a multifaceted disease, which is associated with numerous of clinical manifestations. Type 2 diabetes considered another conditions added to HCV complications It is a complex and multisystem disease with a pathophysiology that includes a defect in insulin secretion, increased hepatic glucose production and resistance to the action of insulin Human tumor necrosis factor alpha [TNf alpha] - an unglycozylated polypeptide cytokine- has the ability to inhibit insulin-stimulated glucose uptake. The aim of this study is to investigate the status of insulin resistance expressed as HOMA index in patients with HCV infection, patients with HCV+D.M and its relationship to TNF- alpha level and virus load in comparison with healthy control and another control group with DM but without HCV infection. Group I: control group [n=15], group II: 1-ICV patients [n= 18], group III: HCV patients with D.M [n = 13] and group IV D.M. patients [n=15]. Show that HOMA index was highly significant increased in patients with HCV, HCV+DM and DM compared with control [p<0.001]. Furthermore, patients with HCV+DM had significant increased level in HOMA index compared to those of DM alone [p<0.001]. Serum TNF- alpha level were also significant increased in patients with HCV and HCV + DM compared with patients with D.M alone and to control group [p<0.001]. HCV RNA load showed a significant cotrelation with both HOMA index and TNF-a levels [r=0.81 1 and 0.848, respectively] [p<0.001]. In conclusion this study showed that HCV infection induces insulin resistance through increased TNF- alpha secretion. The degree of insulin resistance is directly proportional to the virus load