title: Hepatic steatosis in genotype 4 chronic hepatitis C is mainly because of metabolic factors.
abstract: OBJECTIVE
  Hepatic steatosis is considered to be mostly associated with viral factors in genotype 3 and metabolic factors in genotype 1 chronic hepatitis C, while there are rather few data for genotype 4. We determined the parameters associated with steatosis in 350 chronic hepatitis C patients, focusing on genotype 4.
  
  
  METHODS
  Histological lesions were evaluated according to Ishak's classification and steatosis was semiquantitatively graded. Several patient characteristics on the biopsy day were also evaluated.
  
  
  RESULTS
  Steatosis was present in 73% of patients without significant differences among genotypes. Moderate/severe steatosis was more frequent in genotype 3 than 4 (44% vs 26%, P= 0.025) and similar between genotype 4 and 1 patients. Moderate/severe steatosis was associated with body mass index (BMI) in genotype 4 (P= 0.023) and gamma-glutamyl-transpeptidase in genotype 3 patients (P= 0.044). In 150 nondiabetic patients with BMI < or =25 kg/m(2), moderate/severe steatosis was present in 15, 40, and 11% of genotype 1, 3, and 4 patients, respectively, (P= 0.005) and was independently associated only with genotype 3. In multivariate analysis, steatosis grade or moderate/severe steatosis was independently associated with higher BMI, genotype 3, and lower cholesterol.
  
  
  CONCLUSIONS
  Moderate or severe steatosis is significantly less frequent in genotype 4 than 3 chronic hepatitis C patients and similar between genotype 4 and 1. In nondiabetic, nonoverweight patients, moderate or severe steatosis is present in only 10-15% of genotype 4 or 1 compared with 40% of genotype 3 patients. Thus, hepatic steatosis in genotype 4 is mostly associated with metabolic factors, similar to those in genotype 1.
authors.affiliation: 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital, Athens, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.forename: George V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.forename: Emanuel K
authors.initials: EK
authors.lastname: Manesis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Chrysanthos
authors.forename: Georgia
authors.initials: G
authors.lastname: Kafiri
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Petraki
authors.forename: Emilia
authors.initials: E
authors.lastname: Hadziyannis
authors.forename: Helen
authors.initials: H
authors.lastname: Pandelidaki
authors.forename: Rodessa
authors.initials: R
authors.lastname: Zafiropoulou
authors.forename: Savvas
authors.initials: S
authors.lastname: Savvas
authors.forename: John
authors.initials: J
authors.lastname: Koskinas
authors.forename: Athanasios J
authors.initials: AJ
authors.lastname: Archimandritis
mesh_terms: D000328:Adult; D001706:Biopsy; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D005234:Fatty Liver / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D002784:Cholesterol