title: Effects of fatty liver and related factors on the efficacy of combination antiviral therapy in patients with chronic hepatitis C.
abstract: OBJECTIVE
  Hepatic steatosis is a histological feature in patients with chronic hepatitis C (CHC) and adversely affects the virologic response rates to anti-hepatitis C virus (HCV) therapy. The aim of this study is to investigate whether the fatty liver and related factors have impact on the efficacy in CHC treated with peginterferon and ribavirin, and the associations between HCV genotyping and fatty liver.
  
  
  METHODS
  Ninety-eight patients received subcutaneously 180 mug peginterferon alpha-2a once a week plus ribavirin. HCV genotypes and the levels of plasma insulin of patients were measured. Fatty liver was detected by B ultrasound. The body mass index (BMI), waist-to-hip ratio (WHR) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.
  
  
  RESULTS
  Among 98 CHC patients, 38 (38.8%) were infected with genotype 1; 44 (44.9%) with genotype 2; 13 (13.3%) with genotype 3; 3 (3.0%) with indeterminate genotype. The prevalence of fatty liver was 10.5%, 11.4%, 38.5% in patients infected with HCV genotype 1, 2, 3, respectively, which suggested that the distribution of fatty liver in different HCV genotypes was imbalanced (chi2=6.758, P=0.034). In univariate analysis, the efficacy of combination therapy was significantly associated with BMI (P=0.011), WHR (P=0.024), the levels of plasma insulin (P=0.001), genotype (P=0.036), presence of fatty liver (P=0.028), treatment dosage and duration (P=0.012) and HOMA-IR (P=0.002). With binary logistic regression analysis, the plasma insulin levels and HOMA-IR showed independent predictors to the efficacy of antiviral therapy.
  
  
  CONCLUSIONS
  The prevalence of fatty liver in HCV genotype 3 was markedly higher than that of other genotypes. The BMI, WHR, the levels of plasma insulin, genotype, presence of fatty liver, treatment dosage and duration and HOMA-IR were associated with the sustained virologic response. The level of plasma insulin and HOMA-IR were independent factors for predicting effect of antiviral therapy.
authors.affiliation: Department of Infectious Diseases, The Second Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Jian Wu
authors.forename: Li
authors.initials: L
authors.lastname: Shu Chen
authors.forename: Wang
authors.initials: W
authors.lastname: Gui Qiang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002681:China; D004359:Drug Therapy, Combination; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000472:pathogenicity; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D000998:Antiviral Agents; D007328:Insulin; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a