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Hepatitis C With Fatty Liver Increases Risk

January 5, 2005

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The following article comments on a study published in the January issue of the medical journal, Hepatology.

It starts out saying that the usefulness of antiviral therapy in patients with mild Hepatitis C is debatable. This indicates that the degree of steatosis in Hepatitis C patients should be one of the metrics in deciding on proceeding with interferon combination therapy.

Again, doctors will tend to prescribe therapy to 100% of patients who present with chronic Hepatitis C (because it is the only medical treatment available to them). This study is one more that calls into question this approach. Assessment of risk/reward ratio before proceeding with therapy needs to take this criterion into consideration, as well as others.

What is not stated in the author’s conclusion is that they would not necessarily recommend antiviral therapy in patients with mild chronic Hepatitis C who do not present steatosis. Impact of Steatosis on the Progression of Fibrosis in Patients with Mild Hepatitis

In patients with mild hepatitis C, the usefulness of antiviral therapy is a subject of debate, as a low risk for progression of fibrosis is assumed. Several studies have shown that steatosis (fatty liver) is a strong and independent predictor of the severity as well as the progression of fibrosis in chronic hepatitis C.

The present study assessed the impact of steatosis on the progression of fibrosis between paired liver biopsies in untreated patients with mild hepatitis on index biopsy.

One hundred thirty-five untreated patients (mean age, 38 years; M/F sex ratio, 1.43) with one known risk factor of infection (68 transfusions, 67 injecting drug use) had 2 liver biopsies after a median interval of 61 months (18-158). All had METAVIR score of A1F1 or lower at first liver biopsy.

Unequivocal progression of fibrosis was considered if patients had a fibrosis score of 3 or 4 at the second liver biopsy. The probability of progression of fibrosis was estimated by using the Kaplan-Meier method.

During follow-up, progression of fibrosis occurred in 21 patients (16%) after a median delay of 65 months. Cumulative probabilities of the progression of fibrosis at 4 and 6 years were 5.2% and 19.8%, respectively.

In multivariate analysis, steatosis was the only independent factor predictive of progression of fibrosis. Probability of progression of fibrosis was significantly related to the percentage of hepatocytes with steatosis.

The authors conclude, “Steatosis is a major determinant of the progression of fibrosis in mild hepatitis C, regardless of the genotype. Our results argue for antiviral treatment in the subgroup of patients with mild hepatitis and steatosis.”

01/05/05

Reference
L Fartoux and others. Impact of steatosis on progression of fibrosis in patients with mild hepatitis. Hepatology 41(1): 82-87. January 2005.

 

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