Obesity, metabolic syndrome, hepatic steatosis, fibrosis and viral load as negative factors affecting early (EVR) and sustained (SVR) virological response in patients with chronic hepatitis c treated with peginterferon and ribavirin

Abagiu M Tataru; E F Georgescu; R Teodorescu; L Stanescu

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Endocrine Abstracts (2011) 26 P303

ECE2011 Poster Presentations Obesity (47 abstracts)

Obesity, metabolic syndrome, hepatic steatosis, fibrosis and viral load as negative factors affecting early (EVR) and sustained (SVR) virological response in patients with chronic hepatitis c treated with peginterferon and ribavirin

M Tataru Abagiu ¹ , E F Georgescu ^1, , R Teodorescu ² & L Stanescu ^1,

Err

Author affiliations

¹Filantropia University Hospital, Craiova, Romania; ²University of Medicine and Pharmacy, Craiova, Romania.

Our aim was to evaluate the impact of some clinical (obesity, metabolic syndrome), biochemical (HOMA-IR), histological (fibrosis, necroinflammation, steatosis) and viral factors (HCV viraemia) on both EVR and SVR in patients with genotype 1 chronic hepatitis C (CHC) treated with peginterferon plus ribavirin.

Patients and methods: We evaluated retrospectively 188 naïve patients with CHC treated with peginterferon plus ribavirin at standard weight-based doses for 48 weeks (96M/92F; mean age 42.75±0.84; mean weight 69.63±1.11 Kg; mean BMI 24.03±0.4). Biopsies were assessed for inflammatory activity and fibrosis, as quantified by the modified Knodell histological activity index. Steatosis was categorized by the proportion of hepatocytes per low-power field with fatty changes: >5%, >5–33%, 34–66%, >66%. All patients were evaluated for metabolic syndrome (MS) using the NCEP-ATP III criteria. All parameters were introduced in multivariate analysis in order to evaluate their contribution to EVR and SVR.

Results: EVR was achieved in 115/188 pts (61.17%) while SVR occurred in 82/115 (71.3%). After adjusting for sex and age, independent factors that negatively interfered with both EVR and SVR were: fibrosis score (OR: 0.478; 95% CI: 0.140–0.912; P=0.031), steatosis (OR: 0.138; 95% CI: 0.035–0.537; P=0.004), HOMA-IR index (OR: 0.478; 95% CI: 0.266–0.857; P=0.013) and viral load (OR: 0.424; 95% CI: 0.240–0.746; P=0.003). After excluding the patients with MS criteria (n=32), EVR was observed in 102/156 (65.4%) and SVR in 82/102 (80.4%). Factors that independently influenced both EVR and SVR were: fibrosis score (OR: 0.468; 95% CI: 0.295–0.743; P=0.001), steatosis (OR: 0.535; 95% CI: 0.342–0.834; P=0.006), obesity (OR: 0.779; 95% CI: 0.650–0.935; P=0.007) and viral load (OR: 0.784; 95% CI: 0.650–0.945; P=0.011).

Conclusion: Fibrosis, steatosis and obesity, as well as viral load are independent parameters that can affect both EVR and SVR in genotype 1 CHC patients treated with peginterferon and ribavirin at standard doses for 48 weeks, regardless the presence of MS. If MS is present, HOMA-IR index can also additionally impair viral response.