Impact of Hepatic steatosis on response to antiviral therapy in Egyptian patients with chronic Hepatitis C

Background and study aim: Hepatic steatosis in hepatitis C virus (HCV) infected patients has been shown to enhance the progression of liver fibrosis and decrease the response to antiviral therapy. The current study is designed to investigate the impact of hepatic steatosis on the outcome of pegylated interferon and ribavirin combination therapy in patients with chronic hepatitis C genotype 4. Patients and Methods: A total number of 200 patients were selected from 270 patients who were referred to HCV Treatment Unit of New Mansoura General Hospital from February 2012 to August 2013 after taking an informed consent. They were 129 males and 71 females, their ages ranged from 25 to 55 years (mean value, 35.5±15.2). They had proven chronic hepatitis C virus based on history of exposure, clinical manifestations, positive anti-HCV antibody, positive HCV viremia, and liver biopsy findings suggestive of chronic hepatitis C. Results: Group I: included 100 patients (70 men and 30 women; mean age of 42.912 years) without liver steatosis. Group II: included 100 patients (59 men and 41 women; mean age of 45.2311 years) with liver steatosis. In terms of steatosis grading using the NAS and METAVIR scoring systems, 50% had no staetosis while 8.5% had mild staetosis, 18.5% had moderate steatosis and 23% had severe steatosis. Body mass index of patients receiving interferon is significant between both groups. Hepatomegaly shows significant values between both groups. Platelets count, ALT, AST, S.Cholesterol & S.Triglycerides levels has statistically significant differences between group I (non steatotic) and group II (steatotic). There is statistically significant difference between both groups on necro-inflamatory activity grades. High statistical significance difference between grading of steatosis and Necro-inflammation. Statistical significance difference between grading of steatosis and fibrosis stages. Statistical significance difference between both groups at SVR and Steatosis has a negative effect on SVR by comparison to non steatotic group. High degree of hepatic steatosis has a negative impact on pagylated interferon and ribavirin therapy in chronic HCV genotype 4 minimizing sustained virologic response rates. Conclusion: Our study confirms that hepatic steatosis correlates with BMI, S.cholesterol, S.triglycerides, fibrosis, necro-inflammatory stages and has a negative impact on response to antiviral therapy

Mean Platelet Volume as a Fibrosis Marker in Patients with Chronic Hepatitis C

Background and study aim: Liver biopsy limitations push us to search for new non invasive methods to detect liver fibrosis such as serum markers. The aim of this study is to evaluate mean platelet volume (MPV) as a fibrosis marker in patient with chronic hepatitis C. Patients and methods: 150 patients diagnosed with chronic hepatitis C infection refereed to Tanta Fever Hospital in period from May 2013 to January 2014 and 20 healthy volunteers as a control were included. All of them were tested for Mean Platelet Volume (MPV) in comparison with who done liver biopsy as standard. Results: Statistically significant differences in MPV and Platelet Count were seen in patients with chronic hepatitis C (CHC) compared to healthy controls (MPV: 8.95 ± 1.39fL vs. 7.57 ± 0.68 fl, P-value = 0.043; PC 226.03 ±68.36 vs. 188.9±46.49, P-value = 0.02) Multi-variate Logistic regression analysis shows only 5 variables remained as independent risk factors for fibrosis progression: (MPV, Schistosomiasis, ALT, AST and Prothrombin time). AST (OR 1.11, 95% CI 1.02 to 1.21), ALT (OR 0.92, 95% CI 0.86 to 0.99), PT (OR 2.11, 95% CI 1.15 to 3.88), and MPV (OR 2.28, 95% CI 1.22 to 4.25). Cut-off values were calculated for diagnostic performance, and the cut-off value for MPV was 9.22 fl., sensitivity 75.5%, specificity 62%, PPV 40.3%, NPPV 93.4% and Accuracy rate 61.8%. Conclusion: We suggest that high MPV levels (especially those over 9.22 fl) may help to predict advanced fibrosis in patients with CHC. However, it should not be forgotten that MPV is not a specific marker for fibrosis, and the negative predictive rate seems more valuable to exclude a high fibrosis ratio in patients with CHC