Hepatitis C and B;Fibrosis severity in Hepatic steatosis/insulin resistance

Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection

Salvatore Petta1, Calogero Camm? 1, Vito Di Marco1, Fabio Salvatore Macaluso1, Marcello Maida1, Giuseppe Pizzolanti2, Beatrice Belmonte3, Daniela Cabibi3, Rosa Di Stefano4, Donatella Ferraro4, Carla Guarnotta3, Giovanna Venezia1, Antonio Craxì1

Article first published online: 30 JAN 2011
DOI: 10.1111/j.1478-3231.2011.02453.x
© 2011 John Wiley & Sons A/S
Issue
Liver International

Abstract

Background and aims: Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the factors related to steatosis and IR in CHB patients, compared with CHC subjects, and to evaluate the potential association between these features and fibrosis severity.

Material and methods: One hundred and seventy consecutive patients with CHB (28 HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and metabolic measurements and matched for sex, age and body mass index with 170 genotype 1 CHC patients. IR was defined if HOMA-IR more then 2.7. All biopsies were scored for grading and staging by Scheuer's score, and the steatosis was considered significant if more then 10%.

Results: The prevalence of significant steatosis was similar in both CHB and CHC patients (31 vs. 38%; P=0.14). IR rate was significantly higher in CHC than in CHB patients (42 vs. 26%; P=0.002).

Severe fibrosis (F3–F4), at multivariate analysis, was independently associated with older age (OR 1.050, 95% CI 1.009–1.093), steatosis more the 10% (OR 4.375, 95% CI 1.749–10.943), and moderate–severe necroinflammatory activity (OR 8.187, 95% CI 2.103–31.875), regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95% CI 1.028–1.136), IR (OR 2.640, 95% CI 1.110–6.281), steatosis more then 10% (OR 3.375, 95% CI 1.394–8.171), and moderate–severe necroinflammatory activity (OR 8.988, 95% CI 1.853–43.593) in CHC patients.

Conclusions: CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate. Both steatosis and IR in CHC, and only steatosis in CHB, are independently associated with fibrosis severity.

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02453.x/abstract