The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients

Background/Aims: Questions remain regarding the etiology of steatosis in hepatitis C, and its impact on disease progression and treatment outcomes. Methods: We evaluated liver biopsies from 574 patients with chronic hepatitis C from a single center. Results: Severity of steatosis was associated with body mass index, HCV genotype 3 infection, age, and duration of infection (P≤0.01). Serum HCV RNA levels were associated with severity of steatosis in HCV genotype 3 infection (P≤0.03). In HCV genotype 1 infection, fibrosis was associated with severity of steatosis (P<0.01), and patients who achieved SVR had lesser degrees of pre-treatment steatosis compared to nonresponders (4.6±1.6 vs. 10.1±1.1%, P=0.02). Genotype 1 infected patients with an early virologic response were more likely to have grade 0 steatosis compared to those without an early response (71 vs. 42%; P=0.003). Evaluation of paired biopsies demonstrated a marked decline in steatosis in genotype 3 patients who achieved SVR (P<0.01). Conclusions: In conclusion, steatosis is an important cofactor in hepatitis C as it is associated with fibrosis and reduces the likelihood of achieving early and sustained virologic response in genotype 1 infected patients.