Evolution of hepatic steatosis in patients with advanced hepatitis C: results from the hepatitis C antiviral long-term treatment against cirrhosis (HALT-C) trial
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, Gyongyi Szabo, Barbara F Banner, Maureen Cormier, Donna Giansiracusa, Michelle Kelley, Bruce Bacon, Brent Neuschwander-Tetri, Elizabeth M Brunt, Debra King, Jules L Dienstag, Andrea E Reid, Atul K Bhan, Wallis A Molchen, S Russell Nash, Jennifer DeSanto, Carol McKinley, Timothy R Morgan, John R Craig, M Mazen Jamal, Muhammad Sheikh, Choon Park, Thomas E Rogers, Janel Shelton, Nicole Crowder, Rivka Elbein, Nancy Liston, Sugantha Govindarajan, Carol B Jones, Susan L Milstein, Robert J Fontana, Pamela A Richtmyer, R Tess Bonham, Mitchell L Shiffman, Melissa J Contos, Scott Mills, Charlotte Hofmann, Paula Smith, T Jake Liang, David Kleiner, Yoon Park, Elenita Rivera, Vanessa Haynes-Williams, Leonard B Seeff, Patricia R Robuck, Jay H Hoofnagle, Elizabeth C Wright, David R Gretch, Minjun Chung Apodaca, Rohit Shankar, Kristin K Snow, Anne M Stoddard, Margaret C Bell, Zachary Goodman, 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, Gyongyi Szabo, Barbara F Banner, Maureen Cormier, Donna Giansiracusa, Michelle Kelley, Bruce Bacon, Brent Neuschwander-Tetri, Elizabeth M Brunt, Debra King, Jules L Dienstag, Andrea E Reid, Atul K Bhan, Wallis A Molchen, S Russell Nash, Jennifer DeSanto, Carol McKinley, Timothy R Morgan, John R Craig, M Mazen Jamal, Muhammad Sheikh, Choon Park, Thomas E Rogers, Janel Shelton, Nicole Crowder, Rivka Elbein, Nancy Liston, Sugantha Govindarajan, Carol B Jones, Susan L Milstein, Robert J Fontana, Pamela A Richtmyer, R Tess Bonham, Mitchell L Shiffman, Melissa J Contos, Scott Mills, Charlotte Hofmann, Paula Smith, T Jake Liang, David Kleiner, Yoon Park, Elenita Rivera, Vanessa Haynes-Williams, Leonard B Seeff, Patricia R Robuck, Jay H Hoofnagle, Elizabeth C Wright, David R Gretch, Minjun Chung Apodaca, Rohit Shankar, Kristin K Snow, Anne M Stoddard, Margaret C Bell, Zachary Goodman
Abstract
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.
Trial registration: ClinicalTrials.gov NCT00006164.
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Source: PubMed