Obesity, metabolic syndrome, hepatic steatosis, fibrosis and viral load as negative factors affecting early (EVR) and sustained (SVR) virological response in patients with chronic hepatitis c treated with peginterferon and ribavirin
M Tataru Abagiu1, E F Georgescu1,2, R Teodorescu2 & L Stanescu1,2
Our aim was to evaluate the impact of some clinical (obesity, metabolic syndrome), biochemical (HOMA-IR), histological (fibrosis, necroinflammation, steatosis) and viral factors (HCV viraemia) on both EVR and SVR in patients with genotype 1 chronic hepatitis C (CHC) treated with peginterferon plus ribavirin.
Patients and methods: We evaluated retrospectively 188 naïve patients with CHC treated with peginterferon plus ribavirin at standard weight-based doses for 48 weeks (96M/92F; mean age 42.75±0.84; mean weight 69.63±1.11 Kg; mean BMI 24.03±0.4). Biopsies were assessed for inflammatory activity and fibrosis, as quantified by the modified Knodell histological activity index. Steatosis was categorized by the proportion of hepatocytes per low-power field with fatty changes: >5%, >533%, 3466%, >66%. All patients were evaluated for metabolic syndrome (MS) using the NCEP-ATP III criteria. All parameters were introduced in multivariate analysis in order to evaluate their contribution to EVR and SVR.
Results: EVR was achieved in 115/188 pts (61.17%) while SVR occurred in 82/115 (71.3%). After adjusting for sex and age, independent factors that negatively interfered with both EVR and SVR were: fibrosis score (OR: 0.478; 95% CI: 0.1400.912; P=0.031), steatosis (OR: 0.138; 95% CI: 0.0350.537; P=0.004), HOMA-IR index (OR: 0.478; 95% CI: 0.2660.857; P=0.013) and viral load (OR: 0.424; 95% CI: 0.2400.746; P=0.003). After excluding the patients with MS criteria (n=32), EVR was observed in 102/156 (65.4%) and SVR in 82/102 (80.4%). Factors that independently influenced both EVR and SVR were: fibrosis score (OR: 0.468; 95% CI: 0.2950.743; P=0.001), steatosis (OR: 0.535; 95% CI: 0.3420.834; P=0.006), obesity (OR: 0.779; 95% CI: 0.6500.935; P=0.007) and viral load (OR: 0.784; 95% CI: 0.6500.945; P=0.011).
Conclusion: Fibrosis, steatosis and obesity, as well as viral load are independent parameters that can affect both EVR and SVR in genotype 1 CHC patients treated with peginterferon and ribavirin at standard doses for 48 weeks, regardless the presence of MS. If MS is present, HOMA-IR index can also additionally impair viral response.