Steatosis in hepatitis C virus infection. Response to anti-viral therapy

Abstract

Background: Steatosis is a frequent feature of hepatitis-C-virus (HCV) infection. Steatosis may be an important cofactor in both accelerating fibrosis and increasing liver necroinflammatory activity in chronic hepatitis C. Several studies suggested that steatosis induces resistance to interferon and ribavirin combination treatment.

Aim: to assess the prevalence of steatosis in chronic HCV-infection and the host factors associated with steatosis, to estimate the impact of steatosis on liver fibrosis, and to evaluate the response to antiviral therapy in patients with HCV-infection and steatosis.

Material and method: A retrospective study was performed on 37 patients with chronic active HCV-infection treated with interferon and ribavirin: 21 women and 16 men, mean age 46.97 years. Presence of metabolic syndrome was assessed according to the ATPIII criteria. Cobas Amplicor HCV-Test was used to detect HCV-RNA. Steatosis was graded using the Brunt system.

Results: Prior to the antiviral treatment, steatosis was present in 26 out of 37 patients (70%). Patients with steatosis were older, especially those with associated metabolic syndrome. Fibrosis stage was significantly advanced in patients with steatosis. Lower baseline viremia correlated with sustained response both in patients with and without steatosis. Absence of baseline steatosis was associated with higher biochemical and virological sustained response. None of the patients with metabolic syndrome had a sustained response to antiviral therapy. In all patients, the stage of fibrosis did not significantly improve 6 months after cessation of the antiviral treatment.

Conclusion: Steatosis is a frequently encountered histological feature in chronic HCV-infection. It is associated with older age, lower virologic response and worsening fibrosis irrespective of antiviral treatment.