Study the Relationship Between Obesity and Hepatitis C Replication

A Randomized, Partially Blinded, Pilot Study of the Effects of Pioglitazone on HCV RNA in Overweight Subjects With Chronic HCV Genotypes 1 or 4 Infection.

Patients with chronic hepatitis C viral infection (HCV) and with a BMI greater than 25Kg/m2 are refractory to medical treatment. Also, HCV replication seems to be affected when modeling insulin resistance in replicon cell culture systems.

PPARg -agonist (Pioglitazone) is effective in controlling liver inflammation in obese subjects with non-alcoholic steatohepatitis (NASH) and also improving insulin sensitivity. Therefore, we hypothesize that improving insulin resistance and /or inflammation may affect HCV replication and viral kinetics. Independently of PPARg pathways, Prednisone may increase HCV viral kinetics. .

This is a randomized, two arm clinical trial. The investigators performing the primary and secondary endpoints are blinded to subject identifiers and arm identifiers.

Subject's screening for HCV Genotype 4 started in Agouza Hospital in July 2010 and ended in February, 2011. No recruitment has occurred for HCV Genotype 1.

Inclusion Criteria:

• Infection with HCV genotype 1 or 4 (subjects infected with multiple genotypes are not eligible)
• BMI greater than 25 Kg/m2
• HCV-infected subjects naïve to treatment: subjects who either have never been treated for HCV infection or who previously received HCV treatment ending more than 3 months prior to enrollment for not longer than 2 weeks
• Plasma HCV RNA concentration of >10,000 IU/mL at the screening evaluation

Exclusion Criteria:

• Previous intolerance to Pioglitazone, Rosiglitazone, Troglitazone or corticosteroids
• Women who are pregnant or breastfeeding
• History of diabetes mellitus requiring treatment other than diet
• Decompensated liver disease or other known causes of liver disease including, but not limited to autoimmune hepatitis, Wilson's disease, hemochromatosis, primary biliary cirrhosis, schistosomiasis, sclerosing cholangitis, alcohol- or drug-induced liver disease, or alpha-one antitrypsin deficiency
• Concurrent hepatitis B virus (HBV) infection
• Known immunodeficiency disease, autoimmune disorders or active gastrointestinal disease
• Abuse of alcohol or illicit drugs within 6 months before enrollment
• Use of an investigational drug within 4 weeks before the screening visit or during the screening period.
• Use of systemic immunosuppressants
• History of poorly controlled psychiatric disease or poorly controlled pulmonary disease