Steatosis and chronic hepatitis C: analysis of fibrosis and stellate cell activation

Background/Aims: Steatosis is a frequent histological finding in chronic hepatitis C and is associated with increased hepatic fibrosis. Methods: We studied 80 patients with untreated chronic hepatitis C to determine whether steatosis contributes to fibrosis through a steatohepatitis-like pathway. Results: Fine sinusoidal and/or central vein fibrosis was present in 52 patients (65%). This was typically located in acinar zone 3 and had a chicken-wire appearance similar to that seen in steatohepatitis. A statistically significant relationship was found between subsinusoidal fibrosis and age (rs=0.33, P=0.003) and grade of steatosis (rs=0.35, P=0.001). Mean body mass index was higher in patients with focal (28.4±4.7 kg/m2) or extensive (29.6±5.9 kg/m2) subsinusoidal fibrosis than in those patients with no subsinusoidal fibrosis (25.5±3.7 kg/m2). The extent of α-smooth muscle actin staining (as a marker of stellate cell activation) correlated with the degree of portal inflammation and the stage of portal fibrosis, but not with the grade of hepatic steatosis. Conclusions: These findings suggest that in hepatitis C infection, host factors, particularly adiposity, contribute to both steatosis and acinar fibrosis. The implication of these observations is that weight reduction may provide an important therapeutic strategy for patients with chronic hepatitis C.