Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

Introduction Chronic hepatitis B virus (HBV) infection and liver steatosis (LS) are the most common causes of chronic liver disease, and their coexistence is frequently observed in clinical practice. Although metabolic syndrome is the main cause of LS, it has not been associated with HBV infection. The aims of this study were to describe the lipid profile and prevalence of LS among HBV carriers and to identify the characteristics associated with LS in this group. Methods This retrospective cross-sectional study included hepatitis B surface antigen (HBsAg)-positive patients evaluated during 2011 and 2012. Results Of the 83 patients included, the mean age was 46.4±12.5 years, 53% were men, and 9.1% were hepatitis B e antigen (HBeAg) -positive. These patients exhibited the following lipid profile: total cholesterol = 175.4±38.8mg/dL, low-density lipoprotein (LDL) = 113.0±32.7mg/dL, and triglycerides = 91.1±45.2mg/dL. Their fasting glucose was 95.3±14.5g/dL, and fasting insulin was 6.1±5.9µIU/mL. Liver steatosis was observed on abdominal ultrasound in 11.3% of individuals. Factors associated with the presence of LS included higher levels of total cholesterol, prothrombin activity, fasting insulin, and body mass index (BMI) as well as lower levels of aspartate aminotransferase (AST). Conclusions These findings suggest that LS in patients with chronic HBV appears to be a consequence of metabolic alterations and insulin action rather than of viral factors. .

Estudio sobre la sobrecarga de hierro en pacientes con hepatitis C crónica / [A study on hepatic iron overload in chronic hepatitis C patients].

BACKGROUND: Hepatitis C is a worldwide chronic liver disease. Different factors have been found to be associated with an increased progression to severe liver fibrosis, such as alcohol intake higher than 30 g/day, older age at infection and co-infection. Nevertheless, different research centers have found conflicting data concerning the liver iron overload fibrogenic role. AIM: To assess the association between hepatic iron overload and fibrosis stage grades in hepatitis C Virus carriers, hepatic steatosis and demographic variables. METHODS: In this descriptive study we recruited 290 positive anti-HCV and qualitative HCV-RNA, treatment naive chronic hepatitis C outpatients registered fom 2007 to 2009 at the Federal University of Bahia’s Hospital. The variables studied in the liver biopsy results were: 1) fibrosis stage according to META VIR score (F0-F4), 2) iron overload presence or absence according to Perls staining, and 3) presence or absence of steatosis. Fibrosis stages were categorized as mild/moderate (F0-F2) and severe (F3-F4). Exclusion criteria were hepatitis B virus and human immunodeficiency virus co-infection, and primary or secondary hemochromatosis. The statistical analysis was performed using Chi-square and Student’s t tests, with the ssoftware: SPSS 17. A P value < 0.05 was considered as significant. RESULTS: Severe fibrosis was statistically associated with older age, iron overload presence (P = 0.003) and steatosis (P = 0.01). CONCLUSIONS: In this study hepatic iron overload and hepatic steatosis were associated with severe hepatic fibrosis (METAVIR F3-F4).

Analysis of the sustained virological response in patients with chronic hepatitis C and liver steatosis / Análise da resposta virológica sustentada em pacientes com hepatite crônica pelo vírus da hepatite C e esteatose hepática

CONTEXT: Chronic hepatitis C as well as non-alcoholic fatty liver disease are recognized as the main cause of liver disease in Western countries. It is common to see the concomitance of the diseases and the influence of steatosis in the sustained virological response of patients with hepatitis C virus. OBJECTIVE: Assess the sustained virological response in chronic hepatitis C patients according to the presence of liver steatosis. METHODS: One hundred sixty patients with chronic hepatitis C were retrospectively evaluated. Demographic data such as gender, age, body mass index, presence of diabetes mellitus and systemic arterial hypertension, virus genotype and use of pegylated interferon were analyzed, as was the staging of fibrosis and the presence of steatosis at histology. RESULTS: Most patients were male (57.5 percent), with a mean age of 48 ± 9.7 years. The most frequent genotype observed was 3 (56.9 percent) and, in the histological evaluation, steatosis was observed in 65 percent of the patients (104/160). Sustained virological response in patients with steatosis occurred in 38.5 percent, and in 32.1 percent in patients without steatosis (P = 0.54). When we analyzed possible factors associated with the presence of steatosis, only body mass index and systemic arterial hypertension revealed a significant association. When the factors that influenced sustained virological response were evaluated in a logistic regression, genotype and use of pegylated interferon proved to be independent factors associated to the response. CONCLUSION: In the evaluated patients the presence of liver steatosis did not influence the sustained virological response of patients with chronic hepatitis C treated with interferon and ribavirin.

CONTEXTO: Tanto a hepatite crônica pelo vírus C quanto a doença hepática gordurosa não-alcoólica são reconhecidas como causas frequentes de doença hepática nos países ocidentais. É comum observar a concomitância das duas doenças e a influência da esteatose na resposta virológica sustentada dos pacientes com hepatite crônica pelo vírus C. OBJETIVO: Avaliar a resposta virológica sustentada nos pacientes com hepatite crônica pelo vírus C de acordo com a presença de esteatose. MÉTODOS: Foram avaliados, retrospectivamente, 160 pacientes com hepatite crônica C. Dados demográficos, como sexo, idade, índice de massa corpórea, presença de diabetes mellitus e hipertensão arterial sistêmica, genótipo do vírus e uso de interferon peguilado foram analisados, bem como o estadiamento e a presença de esteatose, quando da histologia. RESULTADOS: A maioria dos pacientes era masculina (57,5 por cento), com média de idade de 48 anos ± 9,7. O genótipo mais frequente foi o 3 (56,9 por cento) e, na avaliação histológica, foi observada esteatose em 65 por cento dos pacientes (104/160). A resposta virológica sustentada nos pacientes com esteatose foi de 38,5 por cento, sendo de 32,1 por cento nos pacientes sem esteatose (P = 0,54). Quando se analisaram possíveis fatores associados à presença de esteatose, somente índice de massa corpórea e hipertensão arterial sistêmica estiveram associados de forma significativa. Quando se avaliaram em regressão logística os fatores que influenciaram a resposta virológica sustentada, genótipo e uso de interferon peguilado mostraram-se fatores independentes associados à resposta. CONCLUSÃO: A presença de esteatose hepática não influenciou a resposta virológica sustentada de pacientes com hepatite crônica pelo vírus C tratados com interferon e ribavirina.

Frequency of steatosis and its relation with the grade of fibrosis in patients with hepatitis C

To study the frequency of steatosis and observe the relation between steatosis and grade of fibrosis in patients with hepatitis C. This descriptive case series study was undertaken at liaquat University of Medical and Health Sciences hospital from July 2005 to November 2007. It included 158 PCR-positive hepatitis C cases with genotype 3. Patients demographic data was enrolled in welt designed proforma BMI was calculated and history of diabetes metlitus was obtained. Liver biopsy was done after written consent and was sent for grading of fibrosis and steatosis. T-test was applied for continuous variables whereas stage of fibrosis was compared with grade of steatosis, BMI and age by chi-square test. 0.05 was made a level of Significance. This study included 158 patients out of which 109 [69%] were male and 49[31%] were female. The mean age of the patient was 36.8 +/- 9.8.The BMI was <25 in 86[54.4%] whereas BMI 25-30 was present inS3 [33.5%] and BMI >30 in 19 [12%] of cases. The steatosis was found in 71[45%] of cases. Mild [<30% of hepatocytes involved] 33[21%], moderate [30-60% hepatocytes involved] in 26 [16.5%] and severe [>60% hepatocytes involved] steatosis in 12[7.5%] cases. A strong correlation between steatosis score and fibrosis stage was observed in our study [P= < 0.001] whereas no relationship was observed between BMI [P = 0.67] or age [P =0.39] with stage of steatosis. This study showed that increased steatosis is associated with worsening fibrosis suggesting a possible role for steatosis in the acceleration of Liver disease in HCV Patients and efforts to control steatosis may therefore have an important role in halting HCV liver disease progression

Esteatose e esteatohepatite não-alcoólica nos pacientes com hepatite crônica pelo vírus da hepatite C / Steatosis and non-alcoholic steatohepatitis in patients with chronic hepatitis due to hepatitis C virus infection

RACIONAL: Esteatose hepática é achado comum na hepatite pelo vírus C (VHC), principalmente nos pacientes com genótipo 3, podendo estar relacionada à resposta ao tratamento antiviral e prognóstico da hepatite crônica OBJETIVO: Determinar a presença de esteatose e de esteatohepatite não-alcoólica na hepatite crônica pelo VHC, correlacionando-as com o genótipo do VHC e com o grau de fibrose hepática. PACIENTES E MÉTODOS: Foram avaliados retrospectivamente 120 pacientes com hepatite crônica pelo VHC. A genotipagem foi avaliada em 102 pacientes. Todos os espécimes de biopsia hepática foram submetidos as colorações: picrosirius, hematoxilina-eosina e perls. O estádio da hepatite C foi realizado de acordo com a Classificação Brasileira e o diagnóstico de esteatohepatite não-alcoólica estabelecido de acordo com os critérios da American Association for the Study of Liver Diseases. O nível de significância considerado na analise estatística foi de 5 por cento RESULTADOS: A esteatose foi encontrada em 65 dos 120 pacientes (54,2 por cento), sendo leve em 37/65 (56,9 por cento), moderada em 12/65 (18,5 por cento) e intensa em 10/65 (15,4 por cento). Quanto à fibrose, 80 de 120 pacientes (66,6 por cento) tinham fibrose entre F0 e F2, e 40 (33,3 por cento) tinham fibrose F3 ou F4. Esteatose foi mais freqüente no genótipo 3 (76,7 por cento) em relação aos demais genótipos (49,0 por cento). Não houve diferença na freqüência de esteatose quando comparados os pacientes com F3/F4 (52,5 por cento) e demais graus de fibrose (54,4 por cento). Esteatohepatite não-alcoólica foi diagnosticada em 8/120 casos (6,7 por cento), sendo significativamente correlacionada com o genótipo 3 e com fibrose avançada (F3/F4) CONCLUSÕES: A presença de esteatose, assim como de esteatohepatite não-alcoólica na hepatite C, estão relacionados ao genótipo 3, sendo a esteatohepatite não-alcoólica correlacionada a graus mais avançados de fibrose.

BACKGROUD: Hepatic steatosis is a common finding in patients with hepatitis C, mainly virus C genotype 3. Steatosis in these cases might be associated with antiviral treatment response and with prognosis of chronic hepatitis. AIMS: To determine the presence of steatosis and non-alcoholic steatohepatitis in chronic hepatitis C and its correlation with genotype and hepatic fibrosis. PATIENTS AND METHODS: One hundred and twenty patients with chronic hepatitis C were retrospectively evaluated; genotype was done in 102 patients. All specimens were stained with hematoxylin-eosin, picrosirius and perls. Staging of hepatitis C was scored by Brazilian Classification and the diagnosis of non-alcoholic steatohepatitis by the American Association for the Study of Liver Diseases criteria RESULTS: Steatosis was found in 65 of 120 cases (54.2 percent); it was mild in 37/65 (56.9 percent), moderate in 12/65 (18.5 percent) and severe in 10/65 (15.4 percent). In relation to fibrosis, 80 of 120 patients had mild fibrosis F0-F2 (66.6 percent) and 40 (33.3 percent) had more advanced fibrosis (F3 or F4). Steatosis was associated with genotype 3 (76.7 percent) in comparison with other genotypes (49,0 percent). There were no relationship between steatosis and advanced fibrosis F3/F4 (52,5 percent) or mild fibrosis (54,4 percent). Non-alcoholic steatohepatitis was diagnosed in 8/120 cases (6.7 percent) and was significantly associated with hepatitis C virus genotype 3 and with advanced fibrosis (F3 and F4) CONCLUSIONS: The presence of steatosis and non-alcoholic steatohepatitis in chronic hepatitis C are associated to genotype 3; moreover non-alcoholic steatohepatitis was correlated with more advanced fibrosis.