The occurrence of liver steatosis in patients with chronic hepatitis C - the experience of the Clinical Center of Vojvodina

Tomislav Preveden; Maja Ružič; Nadica Kovačević; Maria  Pete; Milotka Fabri

doi:10.2298/VSP161115031P

Tomislav Preveden Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Maja Ružič Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Nadica Kovačević Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Maria Pete Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Milotka Fabri Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP161115031P

Keywords: fatty liver;, hepatitis c;, risk factors;, genotype;, hepacivirus;, body mass index.

Abstract

Abstract

Background/ Aim. Hepatic steatosis in individuals with chronic hepatitis C occurs in about half of cases. Its occurrence is influenced by factors of the host and viral factors, and its importance lies in the fact that it reduces the success of antiviral therapy based on interferon in the treatment of chronic hepatitis C and that, associated with other factors, exacerbates liver disease. The objective this paper is to determine the prevalence and severity of steatosis in patients with chronic hepatitis C and to determine the factors that affect its occurrence. Methods. The research includes 123 patients with chronic hepatitis C, in which the diagnosis of liver steatosis was made by a liver biopsy and histopathological examination according to which ≥5% of hepatocytes is affected by the fatty change. Based on the presence of steatosis, the patients were divided into two groups, 43 patients with steatosis, 80 without steatosis. The influence of certain factors on the occurrence of steatosis was examined using standard statistical methods. Results. Liver steatosis was found in 34.96% of subjects with chronic hepatitis C, and most patients had mild steatosis 76.74%. Of the examined predictive factors for the occurrence of steatosis, statistical significance in its occurrence belongs to elevated BMI, genotype 3HCV, and HCV viremia. Conclusion. Hepatic steatosis often occurs in people with chronic hepatitis C, and it is most often mild. The occurrence of hepatic steatosis in our sample was most affected by genotype 3 HCV and HCV viremia level. Hepatic steatosis can reduce the success of antiviral therapy based on interferon and worsen chronic liver disease course. Therefore, we need to recognize it, treat it and remove it.

Author Biography

Maria Pete, Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

Lekar opšte prakse

References

REFERENCES

1. Goodman Z, Ishak K. Histopathology of hepatitis C cirus infec-tion. Semin Liver Dis 1995; 15(1): 70–81.

Adinolfi LE, Rinaldi L, Guerrera B, Restivo L, Marrone A, Giordano M, et al. NAFLD and NASH in HCV Infection: Prevalence and Significance in Hepatic and Extrahepatic Manifestations. Int J Mol Sci 2016; 17(6): pii: E803.

Modaresi EJ, Ansari-Gilani K. Steatosis and hepatitis C. Gas-tro¬enterol Rep (Oxf) 2016; 4(1): 24–9.

Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, Barnes E. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 2015; 61(1): 77–87.

Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epi¬demiology and genotype distribution of the hepatitis C vi-rus infection. J Hepatol 2014; 61(Suppl 1): S45–57.

Masarone M, Federico A, Abenavoli L, Loguercio C, Persico M. Non alcoholic fatty liver: Epidemiology and natural history. Rev Recent Clin Trials 2014; 9(3): 126–33.

Ahmed M. Non-alcoholic fatty liver disease in 2015. World J Hepatol 2015; 7(11): 1450–9.

Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. Int J Med Sci 2006; 3(2): 47–52.

Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol 2014; 61(Suppl 1): S58–68.

Rubbia-Brandt L, Quadri R, Abid K, Giostra E, Malé PJ, Mentha G, et al. Hepatocyte steatosis is a cytopathic effect of hepatitis C virus genotype 3. J Hepatol 2000; 33(1): 106–15.

Castéra L, Hézode C, Roudot-Thoraval F, Lonjon I, Zafrani E, Pawlot¬sky J, et al. Effect of antiviral treatment on evolution of liver steatosis in patients with chronic hepatitis C: Indirect ev-i¬dence of a role of hepatitis C virus genotype 3 in steatosis. Gut 2004; 53(3): 420–4.

European Association for the Study of the Liver (EASL); Eu-ro¬pean Association for the Study of Diabetes (EASD); Euro-pean Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the man-agement of non-alcoholic fatty liver disease. J Hepatol 2016; 64(6): 1388–402.

Bertot LC, Adams LA. The Natural Course of Non-Alcoholic Fatty Liver Disease. Int J Mol Sci 2016; 17(5): pii: E774.

Mishra A, Younossi ZM. Epidemiology and Natural History of Non-alcoholic Fatty Liver Disease. J Clin Exp Hepatol 2012; 2(2): 135–44.

González-Reimers E, Quintero-Platt G, Rodríguez-Gaspar M, Alemán-Valls R, Pérez-Hernández O, Santolaria-Fernández F. Liver steatosis in hepatitis C patients. World J Hepatol 2015; 7(10): 1337–46.

Negro F. Facts and fictions of HCV and comorbidities: Steato-sis, diabetes mellitus, and cardiovascular diseases. J Hepatol 2014; 61(1 Suppl): S69–78.

Wong RJ, Gish RG. Metabolic Manifestations and Complica-tions Associated With Chronic Hepatitis C Virus Infection. Gastroenterol Hepatol (N Y) 2016; 12(5): 293–9.

Abenavoli L, Masarone M, Peta V, Milic N, Kobyliak N, Rouabhia S, et al. Insulin resistance and liver steatosis in chronic hepati-tis C infection genotype 3. World J Gastroenterol 2014; 20(41): 15233–40.

Roingeard P. Hepatitis C virus diversity and hepatic steatosis. J Viral Hepat 2013; 20(2): 77–84.

Macaluso FS, Maida M, Minissale MG, Li Vigni T, Attardo S, Or¬lando E, et al. Metabolic factors and chronic hepatitis C: A complex interplay. Biomed Res Int 2013; 2013: 564645.

Mangia A, Ripoli M. Insulin resistance, steatosis and hepatitis C virus. Hepatol Int 2013; 7(Suppl 2): 782–9.

Del Ben M, Polimeni L, Baratta F, Pastori D, Loffredo L, Angelico F. Modern approach to the clinical management of non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20(26): 8341–50.

Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastro-enterology, and the American Gastroenterological Association. Hepatology 2012; 55(6): 2005–23.

Adinolfi LE, Restivo L, Marrone A. The predictive value of ste-ato¬sis in hepatitis C virus infection. Expert Rev Gastroen¬terol Hepatol 2013; 7(3): 205–13.

Lonardo A, Adinolfi LE, Restivo L, Ballestri S, Romagnoli D, Bal-delli E, et al. Pathogenesis and significance of hepatitis C virus steatosis: An update on survival strategy of a successful patho-gen. World J Gastroenterol 2014; 20(23): 7089–103.

Gambarin-Gelwan M. Viral hepatitis, non-alcoholic fatty liver dis¬ease and alcohol as risk factors for hepatocellular carci-noma. Chin Clin Oncol 2013; 2(4): 32.

Younossi ZM, Otgonsuren M, Henry L, Venkatesan C, Mishra A, Erario M, et al. Association of nonalcoholic fatty liver dis-ease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatology 2015; 62(6): 1723–30.

Younossi ZM, Birerdinc A, Henry L. Hepatitis C infection: A multi-faceted systemic disease with clinical, patient reported and economic consequences. J Hepatol 2016; 65(1 Suppl): S109–19.

Pais R, Barritt SA, Calmus Y, Scatton O, Runge T, Lebray P, et al. NAFLD and liver transplantation: Current burden and ex-pected challenges. J Hepatol 2016; 65(6): 1245–57.

Kleiner DE, Brunt EM, Van NM, Behling C, Contos MJ, Cum-mings OW, Sanyal AJ. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41(6): 1313–21.

Savvoula S, Dimitrios C, George P, Spilios M, Christos T, John G. The impact of host metabolic factors on treatment outcome in chronic hepatitis C. Gastroenterol Res Pract 2012; 2012: 420156.

Khan AN, Said K, Ali K, Gul R. Frequency and severity of ste-ato¬sis in patients with chronic hepatitis-C. J Ayub Med Coll Abbottabad 2015; 27(1): 105–7.

Pais R, Rusu E, Zilisteanu D, Circiumaru A, Micu L, Voiculescu M, et al. Prevalence of steatosis and insulin resistance in pa-tients with chronic hepatitis B compared with chronic hepati-tis C and non-alcoholic fatty liver disease. Eur J Intern Med 2015; 26(1): 30–6.

Werling K, Schaff Z, Dinya E, Tulassay Z. Effect of liver steato-sis on therapeutic response in chronic hepatitis C virus geno-type 1 infected patients in Hungary. Pathol Oncol Res 2010; 16(2): 149–57.

Moroşan E, Mihailovici MS, Giuşcă SE, Cojocaru E, Avădănei ER, Căruntu ID, et al. Hepatic steatosis background in chronic hepatitis B and C - significance of similarities and differences. Rom J Morphol Embryol 2014; 55(3 Suppl): 1041–7.

Irimia E, Mogoantă L, Predescu IO, Efrem IC, Stănescu C, Streba LA, et al. Liver steatosis associated with chronic hepatitis C. Rom J Morphol Embryol 2014; 55(2): 351–6.

Hwang SJ, Lee SD. Hepatic steatosis and hepatitis C: Still un-happy bedfellows? J Gastroenterol Hepatol 2011; 26(Suppl 1): 96–101.

Reddy KR, Govindarajan S, Marcellin P, Bernstein D, Dienstag JL, Bodenheimer H Jr, et al. Hepatic steatosis in chronic hepatitis C: Baseline host and viral characteristics and influence on re-sponse to therapy with peginterferon alpha-2a plus ribavirin. J Viral Hepat 2008; 15(2): 129–36.

Matos CA, Perez RM, Pacheco MS, Figueiredo-Mendes CG, Lopes-Neto E, Oliveira EB, et al. Steatosis in chronic hepatitis C: Re-la¬tionship to the virus and host risk factors. J Gastroenterol Hepatol 2006; 21(8): 1236–9.

Flisiak R, Pogorzelska J, Flisiak-Jackiewicz M. Hepatitis C: Effi-cacy and safety in real life. Liver Int 2017; 37(Suppl 1): 26–32.