Hepatic steatosis in chronic hepatitis C: baseline host and viral characteristics and influence on r

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J Viral Hepat. 2008 Feb;15(2):129-36.

Hepatic steatosis in chronic hepatitis C: baseline host and viral

characteristics and influence on response to therapy with peginterferon alpha-2a

plus ribavirin.

Reddy KR, Govindarajan S, Marcellin P, Bernstein D, Dienstag JL, Bodenheimer H

Jr, Rakela J, Messinger D, Schmidt G, Ackrill A, Hadziyannis SJ.

GI Division, University of Pennsylvania, Philadelphia, PA, USA.

Hepatic steatosis is common in hepatitis C virus (HCV)-infected patients and may

be associated with the metabolic syndrome. We studied steatosis in patients

treated with peginterferonalpha-2a plus ribavirin. Forty-five of 207 patients

(22%) had>5% hepatic steatosis at baseline. Significantly more patients with

steatosis than without were HCV genotype 3 (51%vs 14%; P < 0.0001) had higher

HCV-RNA (P = 0.0045), body weight (P = 0.0176), body mass index (BMI, P =

0.0352) and serum triglycerides (TG) (P = 0.0364), hypertriglyceridaemia (P =

0.0009), elevated blood pressure/history of hypertension (P = 0.0229) and lower

cholesterol (P = 0.0009). Significant steatosis predictors were genotype 3 (OR

9.04, 95% CI 3.85-21.21, P < 0.0001), HCV-RNA (OR 2.96, 1.49-5.88, P = 0.0019)

and triglycerides (OR 1.06, 1.02-1.11, P = 0.0071). In genotype 3 patients,

HCV-RNA was the only significant predictor (OR 11.15, 2.60-47.81, P = 0.0012).

In non-genotype 3 patients, hypertriglyceridaemia was the only significant

predictor (OR 1.07, 1.02-1.12, P = 0.0041). 134 of 207 patients (65%) achieved

an sustained virological response (SVR) with peginterferon alpha-2a plus

ribavirin, similar to the overall response rate. In genotype 3 patients with an

SVR, steatosis decreased from 48% to 13% (baseline to end-point). No change was

seen in the steatosis rate in non-genotype 3 patients with an SVR. This large

and comprehensive analysis of a large data base from a multinational trial

further adds to the observations that chronic HCV is associated with hepatic

steatosis in approximately a fifth of patients. Further, features of the

metabolic syndrome are associated with hepatic steatosis in most of these

patients. Steatosis is significantly more common in genotype 3 compared with

other genotypes, and in these patients, an SVR is associated with steatosis

clearance.

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