The presence of steatosis and elevation of alanine aminotransferase levels are associated with fibrosis progression in chronic hepatitis C with non-response to interferon therapy.
OBJECTIVE
Interferon (IFN) therapy leads to regression of hepatic fibrosis in chronic hepatitis C patients who achieve a sustained virologic response (SVR), while the beneficial effect is limited in those who fail to do so. The aim of the present study was to define factors associated with progression of fibrosis in patients who do not achieve a SVR.


METHODS
Fibrosis staging scores were compared between paired liver biopsies before and after IFN in 97 chronic hepatitis C patients who failed therapy. The mean interval between biopsies was 5.9 years. Factors associated with progression of fibrosis were analyzed.


RESULTS
Fibrosis progressed in 23%, remained unchanged in 47% and regressed in 29%. Steatosis and a high average alanine aminotransferase (ALT) between biopsies were independent factors for progression of fibrosis with risk ratios of 5.53 and 4.48, respectively. Incidence and yearly rate of progression of fibrosis was 64% and 0.22+/-0.29 fibrosis units per year in those with both risk factors compared to 8% and -0.04+/-0.17 fibrosis units per year in those negative for both factors.


CONCLUSIONS
Hepatic steatosis and elevated ALT levels are risk factors for progression of fibrosis in chronic hepatitis C patients who fail to achieve a SVR to IFN therapy and therefore may be therapeutic targets to halt the potentially progressive disease.
Kurosaki
Masayuki
M
Division of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo, Japan.
Matsunaga
Kotaro
K
Hirayama
Itsuko
I
Tanaka
Tomohiro
T
Sato
Mitsuaki
M
Komatsu
Nobutoshi
N
Umeda
Naoki
N
Hosokawa
Takanori
T
Ueda
Ken
K
Tsuchiya
Kaoru
K
Nakanishi
Hiroyuki
H
Itakura
Jun
J
Asahina
Yasuhiro
Y
Miyake
Shozo
S
Enomoto
Nobuyuki
N
Izumi
Namiki
N
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
D007372:Interferons; D000410:Alanine Transaminase