Liver Steatosis in Genotype 4 Patients Is Mainly Due to Metabolic Factors

By Liz Highleyman

Liver steatosis, or accumulation of fat in liver cells, is associated with worse fibrosis progression and poorer response to interferon-based therapy for hepatitis C.

Past studies have shown that various hepatitis C virus (HCV) genotypes are associated with different forms of steatosis. In patients with genotype 1, steatosis is primarily due to metabolic factors such as obesity, while in those with genotype 3, viral factors play a more important role.

As reported in the January 11, 2007 online edition of American Journal of Gastroenterology, Greek researchers analyzed parameters associated with steatosis in 350 chronic hepatitis C patients, focusing on genotype 4, which has been less extensively studied.

Results

• 73% of patients had some degree of steatosis, with no significant differences in prevalence according to genotype.

• However, moderate to severe steatosis was more common in genotype 3 patients than in those with genotype 4 (44% vs 26%; P= 0.025).

• Rates of moderate to severe steatosis were similar in genotype 4 and genotype 1 patients.

• Moderate to severe steatosis was associated with body mass index (BMI) in genotype 4 patients, and gamma-glutamyl-transpeptidase (GGT) level in genotype 3 patients.

• Among 150 non-diabetic subjects with BMI </= 25 kg/m2, moderate to severe steatosis was present in 15% of genotype 1 patients, 40% of genotype 3 patients, and 11% of genotype 4 patients (P= 0.005).

• Moderate to severe steatosis was independently associated only with genotype 3.

• In a multivariate analysis, steatosis grade and presence of moderate to severe steatosis were independently associated with higher BMI, genotype 3, and lower cholesterol.

Conclusion

"Moderate or severe steatosis is significantly less frequent in genotype 4 than 3 chronic hepatitis C patients and similar between genotype 4 and 1," the authors wrote. "In non-diabetic, non-overweight patients, moderate or severe steatosis is present in only 10%-15% of genotype 4 or 1 [patients] compared with 40% of genotype 3 patients."

Thus, they concluded, "hepatic steatosis in genotype 4 [patients] is mostly associated with metabolic factors, similar to those in genotype 1 [patients]."

02/09/07

Reference
E Tsochatzis, G V Papatheodoridis, E K Manesis, and others. Hepatic Steatosis in Genotype 4 Chronic Hepatitis C Is Mainly Because of Metabolic Factors. American Journal of Gastroenterology. January 11, 2007 [Epub ahead of print].