Evolution of hepatic steatosis in patients with advanced hepatitis C: Results from the hepatitis C antiviral long-term treatment against cirrhosis (HALT-C) trial

✍ Scribed by Anna S. Lok; James E. Everhart; Raymond T. Chung; Hae-Young Kim; Gregory T. Everson; John C. Hoefs; Joel K. Greenson; Richard K. Sterling; Karen L. Lindsay; William M. Lee; Adrian M. Di Bisceglie; Herbert L. Bonkovsky; Marc G. Ghany; Chihiro Morishima; HALT-C Trial Group

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 404 KB
• Volume: 49
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.22865

✦ Synopsis

Hepatic steatosis is a common histologic feature in patients with chronic hepatitis C (CHC) but there are no large longitudinal studies describing the progression of steatosis in CHC. We examined changes in steatosis on serial biopsies among CHC patients participating in the Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial. All 1050 patients in the trial had advanced fibrosis at baseline biopsy and were documented not to have had a sustained virological response to peginterferon and ribavirin. Most (94%) patients had genotype 1 infection. At least one protocol follow-up biopsy was read on 892 patients, and 699 had the last biopsy performed 3.5 years after randomization. At enrollment, 39% had cirrhosis and 61% had bridging fibrosis; 18%, 41%, 31%, and 10% had steatosis scores of 0, 1, 2, and 3 or 4, respectively. The mean steatosis score decreased in the follow-up biopsies in both the interferon-treated patients and controls with no effect of treatment assignment (P = 0.66). A decrease in steatosis score by > or =1 point was observed in 30% of patients and was associated with both progression to cirrhosis and continued presence of cirrhosis (P = 0.02). Compared to patients without a decrease in steatosis, those with a decrease in steatosis had worse metabolic parameters at enrollment, and were more likely to have a decrease in alcohol intake, improvement in metabolic parameters, and worsening liver disease (cirrhosis, esophageal varices, and deterioration in liver function).

Conclusion:

Serial biopsies demonstrated that in patients with chc, steatosis recedes during progression from advanced fibrosis to cirrhosis. decreased alcohol intake and improved metabolic parameters are associated with a decline in steatosis and may modulate hepatitis c progression.