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Non-alcoholic Fatty Liver Disease and Hepatitis C
Hepatitis C and non-alcoholic fatty liver disease (NAFLD)
are the two most common liver diseases in the Western hemisphere.
It is therefore natural that these conditions often co-exist
in the same individual.
Hepatitis
C, especially genotype 3, is often associated with hepatic
steatosis. In subjects with genotype 3 infection, a sustained
virologic response to treatment is associated with improvement
in hepatic steatosis.
The
diagnosis of NAFLD in a subject with hepatitis C infection
is based on the presence of hepatic steatosis. Most investigators
require the presence of at least grade II steatosis to warrant
a diagnosis of concomitant NAFLD because the significance
of minimal steatosis is uncertain.
The
presence of steatohepatitis is surmised by the additional
presence of Mallory bodies, cytologic ballooning and pericellular
fibrosis.
It
is of paramount importance to exclude alcohol as a cause of
these histologic findings in this population before a diagnosis
of NAFLD is made.
The
presence of NAFLD in subjects with hepatitis C genotype 1
infection is most strongly associated with the presence of
the metabolic syndrome and insulin
resistance.
The
degree of hepatic steatosis correlates with the degree of
hepatic fibrosis and the presence of concomitant steatosis
is associated with more advanced fibrosis.
The
presence of cytologic ballooning confers an additional risk
for increased fibrosis.
Insulin
resistance and hyperinsulinemia have been associated with
increased collagen production by hepatic stellate cells.
Subjects
with hepatitis C and NAFLD are more likely to be virologic
nonresponders following anti-HCV therapy.
The
value of treating insulin resistance and NAFLD prior to antiviral
therapy remains to be verified.
Division of Gastroenterology, Hepatology and Nutrition,
Virginia Commonwealth University,
Health System, Richmond,
VA, USA.
10/28/05
Reference
A
J Sanjal. Review article: non-alcoholic fatty liver disease
and hepatitis C - risk factors and clinical implications.
Alimentary Pharmacology and Therapeutics 22 (Suppl 2):48-51. November 2005.
See Also
Biochemical
Markers (Fibrotest) Reliably Predict Extensive Fibrosis and
Cirrhosis in Non Alcoholic Fatty Liver Disease (NAFLD)
04/30/04
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