Different mechanisms of steatosis in hepatitis C virus genotypes 1 and 3 infections

Hézode, Christophe; Roudot-Thoraval, F; Zafrani, Élie Serge; Dhumeaux, Daniel; Pawlotsky, Jean‐Michel

doi:10.1111/j.1365-2893.2004.00528.x

Cited by 95 publications

(70 citation statements)

References 28 publications

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“…The association between LS and genotype 3 presumably due to the direct action of HCV [35,36] was also confirmed by both univariate and multivariate analysis. Besides, only in patients with genotype 1, LS was correlated with high BMI and past history of alcohol intake exceeding 50 g/day, in agreement with the pathogenic mechanism of steatosis, principally metabolic, postulated in the patients with this genotype [37]. As regards the correlation between histological steatosis and sonographic findings of steatosis, when all grades of hyperechogenicity were globally considered, BLP showed a relatively high sensitivity for LS (75 %), while the specificity was low (50 %), for the presence of a high number of false positives for LS in the patients with BLP grade 1.…”

Section: Resultssupporting

confidence: 80%

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

Loy¹,

Serra

Chessa

2014

J Ultrasound

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Purpose To evaluate the prevalence of bright liver echo pattern (BLP) on ultrasonography and its correlation with liver steatosis (LS), and fibrosis in patients with chronic hepatitis C. The usefulness of detecting skip areas for steatosis diagnosis has also been evaluated. Methods The study included 88 patients with chronic hepatitis C (55 men, 33 women, average age 45.7 ± 11.2 years). Ultrasound examination was performed in all patients before liver biopsy. The presence of BLP was assessed and graded from 1 to 3. Hypoechogenic areas (skip areas) around the gallbladder or near the portal vein were also evaluated. Hepatic fibrosis was assessed using the Ishak fibrosis score. Steatosis was graded as follows: 1, 2, 3 (\30, 30-70, [70 % of hepatocytes affected, respectively). Results Fifty-three of the 88 patients (60 %) showed BLP (40 grade 1, 13 grades 2 or 3). Skip areas were found in 14 patients (16 %). Histological steatosis was observed in 40 patients (45 %) and in 10 of them (25 %) was grades 2 and 3 (4 and 6 patients, respectively). As regards fibrosis, 2 patients showed F0, 34 F1, 28 F2, 20 F3, 4 F4, none of them F5 and F6. BLP of grades 2 or 3 and presence of skip areas were strongly correlated with LS (P = 0.00007 and P = 0.00003, respectively). No correlation was found between BLP and fibrosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of BLP for LS were 75, 50, 56, 68 and 61 %, respectively. When BLP of grades 2 and 3 and LS of 30 % or more were correlated, the sensitivity, specificity, PPV, NPV and accuracy of BLP were 72, 96, 61, 96 and 90 %, respectively. As regards skip areas the sensitivity, specificity, PPV, NPV and accuracy for LS were 35, 100, 100, 64 and 70 %, respectively. Conclusions In a well-defined group of patients with chronic hepatitis C, the detection of BLP grades 2 and 3 has a good sensitivity and high specificity for high grades of steatosis. A high specificity but low sensitivity for liver steatosis was also found for skip areas, whereas mild fibrosis does not seem to correlate with the hyperechogenicity of the liver.Keywords Liver steatosis Á Ultrasonography Á Bright liver echo pattern Á Skip areas Á Chronic hepatitis C Riassunto Scopo Scopo del lavoro é stato quello di valutare la prevalenza del ''bright liver echo pattern'' (BLP) all'ultrasonografia e la sua correlazione con la steatosi epatica (SE) e la fibrosi in un gruppo di pazienti con epatite cronica C. E' stata valutata anche l'utilità della determinazione delle cosiddette ''aree di risparmio'' per la diagnosi di steatosi. Metodi Lo studio ha incluso 88 pazienti con epatite cronica C (55 di sesso maschile, 33 di sesso femminile; età media 45.7 ± 11.2 anni). L'esame ultrasonografico é stato eseguito in tutti i pazienti prima di effettuare la biopsia epatica. La presenza di BLP é stata graduata da 1 a 3. É stata anche valutata la presenza o meno di aree ipoecogene (cosiddette ''aree di risparmio''), adiacenti alla colecisti o in sede parailare epatic...

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Section: Resultssupporting

confidence: 80%

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

Loy¹,

Serra

Chessa

2014

J Ultrasound

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“…A number of studies have found an association between steatosis and fibrosis stage (1)(2)(3)(4)(5)(6)(7), or between steatosis and necroinflammation in chronic HCV infection (8). Others have found an association between genotype 3 and hepatic steatosis (1,2,(5)(6)(7)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Steatosis and hepatitis C in an Alaska Native/American Indian population

Livingstone

Deubner

McMahon

et al. 2006

International Journal of Circumpolar Health

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Objectives. To determine the prevalence and characteristics of steatosis in Alaska Natives/American Indians (AN/AI) with chronic hepatitis C virus (HCV) infection. Study Design. This outcomes study began in 1994, and 988 AN/AI have been enrolled, including 222 study patients with a positive HCV RNA who underwent liver biopsy. Methods. Study patients were analyzed for sex, age at biopsy, estimated length of infection, body mass index (BMI), genotype, ethanol use, HCV RNA and alanine aminotransferase levels. A pathologist blinded to patient identity and clinical data reviewed all biopsy slides for histologic activity and fibrosis. Results. Moderate to severe steatosis was found significantly more often in genotype 3 than in genotypes 1 and 2 (p = 0.008). On multivariate analysis, BMI > 30 and Ishak fibrosis score ≥ 2 were significantly associated with steatosis (p = 0.0013 and 0.0002, respectively), but only genotype 3 was associated with presence of moderate to severe steatosis (p = 0.008). Conclusions. Our findings in a cohort of AN/AI are consistent with results of previous studies in other groups that steatosis is associated with fibrosis in HCV and infection with genotype 3 is associated with more severe steatosis. (Int J Circumpolar Health 2006:65(3):253-260.)

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“…Distinct genotype-specific pathogenic mechanisms appear to underlie the steatosis in CHC. In HCV genotype 3 infection, [7][8][9][10][11][12][13][14] steatosis is often of moderate to severe intensity, correlates with the levels of intrahepatic viral replication, 7,9,10,12,15,16 and largely resolves after successful antiviral therapy. 9,10,15,17,18 Steatosis may recur on virologic relapse.…”

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confidence: 99%

“…9,10,15,17,18 Steatosis may recur on virologic relapse. Host factors, principally those associated with insulin resistance (IR) and its clinical attributes (obesity and T2DM), 7,[10][11][12]16,19,20 are responsible for the development of steatosis in non-genotype 3 HCV, and steatosis does not ameliorate with antiviral therapy in these patients. 15,18,20 Host variables such as age at infection, 7,11,[21][22][23][24][25][26] the duration of infection, 21,24 male gender, [21][22][23] and excessive alcohol intake 7,11,[21][22][23]27,28 are well-established correlates of advanced hepatic fibrosis in CHC.…”

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confidence: 99%

Genotype-specific interactions of insulin resistance, steatosis, and fibrosis in chronic hepatitis C

Y.¹,

Hui²,

Kench³

et al. 2008

Hepatology

102

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The interaction between insulin resistance (IR), steatosis and genotype to fibrosis in chronic hepatitis C virus (HCV) infection has not been comprehensively assessed. We hypothesized that IR is a key mediator for the development of both steatosis and fibrosis in 346 untreated, nondiabetic patients solely infected with either genotype 1 or 3. We examined for genotype-specific interactions between IR, steatosis and fibrosis by performing subgroup analyses. Because cirrhosis is known to cause IR, we repeated the analysis in a cohort of 313 noncirrhotic HCV-infected patients. We confirmed the impact of IR on fibrosis by analysis of 153 lean subjects in whom any effect of steatosis would be minimized. In HCV genotype 3 patients, increased steatosis was linked to high viral load (P ‫؍‬ 0.001), and was not associated with fibrosis (P ‫؍‬ 0.1). In contrast, body mass index (P ‫؍‬ 0.04) and homeostasis model assessment of insulin resistance (HOMA-IR) (P ‫؍‬ 0.01) contributed directly to steatosis in HCV genotype 1. HOMA-IR rather than steatosis was independently associated with fibrosis for both HCV genotype 1 (OR, 3.22; P ‫؍‬ 0.02) and genotype 3 (OR, 3.17; P ‫؍‬ 0.04). Exclusion of cirrhotic subjects did not alter the findings with respect to the greater contribution of IR compared to hepatic steatosis, as a predictor of fibrosis (P ‫؍‬ 0.02). Genotype-specific subgroup analyses did not alter this finding. The extent of HOMA-IR remained significantly associated with fibrosis in lean patients, independent of the confounding effect of body mass index on IR (OR, 8.02; P ‫؍‬ 0.003). Conclusion: IR is a major independent determinant of fibrosis in chronic HCV infection, regardless of the genotype and the severity of liver damage. (HEPATOLOGY 2008;48:723-731.)

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Different mechanisms of steatosis in hepatitis C virus genotypes 1 and 3 infections

Cited by 95 publications

References 28 publications

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

Steatosis and hepatitis C in an Alaska Native/American Indian population

Genotype-specific interactions of insulin resistance, steatosis, and fibrosis in chronic hepatitis C

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