Steatosis and Long-term Liver Disease Progression after Antiviral Therapy

Steatosis (fatty liver) is recognized as a cofactor influencing the presence and progression of fibrosis in patients with chronic hepatitis C. Studies have shown that antiviral therapy can reduce fibrosis progression, especially in patients who achieve sustained virological response (SVR); treatment also appears to provide some histological benefit for nonresponders and relapsers.

To assess whether steatosis might affect long-term histological outcomes of antiviral therapy, researchers looked at paired liver biopsy results from 161 consecutive patients in Taiwan treated with conventional interferon alfa-2b plus ribavirin. Biopsies samples were taken an average of 29 months apart; about half the participants had genotype 1 HCV, and about half had genotype 2.

Results

Variables associated with baseline steatosis were:

- higher body mass index (25 or higher; P = 0.002);
- higher fibrosis stage (2 or higher; P = 0.019).

Evaluation of paired biopsies showed no difference in the distribution of steatosis evolution between patients with and without SVR (P = 0.374).

Neither the presence nor the severity of steatosis were associated with SVR.

Among patients achieving SVR, there was a significant difference in fibrosis progression between those with grade 0 or 1 steatosis and those with grade 2 or 3 steatosis at the post-treatment biopsy (P = 0.041).

Changes in histological activity index scores did not differ based on steatosis grade (P = 0.740).

Stepwise logistic regression analysis showed that SVR and grade 0 or 1 post-treatment steatosis were independently associated with fibrosis regression.

Conclusion

The authors concluded that, "In patients with chronic hepatitis C, steatosis not only correlates with advanced fibrosis at baseline but also affects fibrosis regression after antiviral therapy."

7/28/06

Reference
C-H Hung, F-Y Kuo, J-H Wang, and others. Impact of steatosis on long-term histological outcome in chronic hepatitis C after antiviral therapy. Antiviral Therapy 11(4): 483-489. 2006.