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Effect of Significant
Histologic Steatosis or Steatohepatitis on Response to Antiviral
Therapy in Patients with Chronic Hepatitis C
Treatment
of chronic
hepatitis C (CHC) results in an average sustained
viral response (SVR) rate of 54%–63%. Most
previous studies have not separately reported SVR rates for
patients who have CHC and concomitant significant hepatic
steatosis (>33%) or histologic evidence
of steatohepatitis
(SH).
The
aim of this study was to evaluate SVR in patients with CHC
plus steatosis or SH on biopsy
examination, compared with a group of controls with CHC and
no significant steatosis or SH.
The
surgical pathology database and clinical files at the Saint
Louis University Liver Center, Saint Louis University, St.
Louis, Missouri, were queried for CHC between 1997 to 2002.
Biopsy specimens with both CHC and significant steatosis (>33%)
or SH were categorized as group 1.
Of
the patients treated with antiviral therapy, information on
either SVR (hepatitis C virus [HCV] RNA negative at 6 months
post-treatment) or lack of SVR (non response as early as 12
weeks into therapy and relapsers) with either standard
interferon (IFN)/ribavirin or pegylated
IFN/ribavirin was found in 84 patients.
A
control group (group 2) of 231 CHC patients was identified
by using a 2-year database (January 2000–June 2001) of patients
without evidence of greater than 33% steatosis or SH.
Results
· The
overall SVR was 28% in group 1, compared with 44% for group
2 (P = .001).
· For
HCV genotype 1, the SVR was 23% vs 34% for group 2 (P
= .19).
· For
HCV genotypes 2 and 3, the SVR was 42% vs 78% for groups 1
and 2 (P = .008), respectively.
The
authors conclude, “Overall SVR for patients with HCV and significant
steatosis or SH is considerably lower than for HCV and steatosis
less than 33% and no SH.”
Discussion
This
study shows that the overall SVR to antiviral therapy in patients
with CHC is decreased significantly when significant steatosis
(>33%) or SH were observed in the biopsy examination. The
reasons for this negative impact on SVR are not entirely clear.
Obesity has been shown to impact negatively on SVR in previous
studies and indeed patients in group 1 were significantly
heavier than patients in group 2.
However,
among patients in group 1, there was no difference in weight
between those patients who achieved an SVR and those who did
not. In fact, on multivariate regression analysis, when stratifying
patients by weight, there was no difference in the risk for
a non response between patients who weighed less than 85 kg
and those who weighed more than 85 kg.
The
authors note, “Therefore, the main determinant of a decreased
SVR in our cohort of patients was the presence of histologically
significant hepatic steatosis or SH, although it should be
noted that the confidence intervals are included when adjusting
for genotype, fibrosis stage, and weight.”
06/29/05
Reference
S
A Harrison and others. Effect of Significant Histologic Steatosis
or Steatohepatitis on Response to Antiviral Therapy in Patients
with Chronic Hepatitis C. Clinical Gestroenterology and Hepatology 3(6):
604-609. June 2005.
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