INS and cryohydrocytosis: In patients with CHC, the presence of steatosis or advanced fibrosis was reported to associate with a reduction in hepatic insulin clearance.29 Reduction in insulin clearance plays an important role in the compensatory response to insulin resistance, and this was associated with increased hepatic lipase activity.30 As our study excluded patients with advanced fibrosis and significant steatosis, it is possible that HCV may mediate hepatic insulin clearance directly, and further studies are needed to delineate the underlying mechanisms.