Clinical Gastroenterology and Hepatology
Volume 8, Issue 1 , Page 97, January 2010

Hepatitis C Virus and Nonalcoholic Fatty Liver Disease: Similar Risk Factors for Necroinflammation, Fibrosis, and Cirrhosis

published online 18 September 2009.

Article Outline

 

Dear Editor:

We read with great interest the recent article by Kallwitz et al,1 recently published in Clinical Gastroenterology and Hepatology. In their article, the investigators showed that both ethnicity and body mass index (BMI) were associated strongly with the severity of liver damage in patients with hepatitis C virus (HCV) infection. The investigators showed that the key predictors of steatosis, necroinflammation, fibrosis, and cirrhosis are as follows: ethnicity (in Hispanics the fibrosis index is higher than in non-Hispanic whites and African Americans) and increased BMI.

In another recent work in this journal, Hanouneh et al,2 using a logistic regression analysis, found that ethnicity, higher BMI, high viral load, genotype 1, higher fibrosis stage, and metabolic syndrome, were significantly associated with a lack of sustained virologic response. Thus, HCV infection needs to be viewed not only as a chronic liver disease but also as a metabolic disease.

Interestingly, the same risk factors lead to steatosis, necroinflammation, fibrosis, and cirrhosis during nonalcoholic fatty liver disease (NAFLD). In addition, HCV chronic infection resembles NAFLD in numerous features including the presence of steatosis, necroinflammation, and fibrosis, as well as insulin resistance and oxidative stress in the liver.3

These findings reinforce the idea that the pathways involved in the pathogenesis of hepatic steatosis, inflammation, and fibrosis could be quite similar regardless of etiology.

Furthermore, the clinical impact of these results is remarkable because it significantly could influence the management of patients with both HCV- and NAFLD-associated liver damage, suggesting that lifestyle intervention and treatments directed against metabolic syndrome also could improve hepatitis C presentation and progression.

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References 

  1. Kallwitz ER, Layden-Almer J, Dhamija M, et al. Ethnicity and body mass index are associated with hepatitis C presentation and progression. Clin Gastroenterol Hepatol. 2010;8:xxx–xxx
  2. Hanouneh IA, Feldstein AE, Lopez R, et al. Clinical significance of metabolic syndrome in the setting of chronic hepatitis C virus infection. Clin Gastroenterol Hepatol. 2008;6:584–589
  3. Balsano C, Alisi A, Nobili V. Liver fibrosis and therapeutic strategies: the goal for improving metabolism. Curr Drug Targets. 2009;10:505–512

 Conflicts of interest The authors disclose no conflicts.

PII: S1542-3565(09)00888-X

doi:10.1016/j.cgh.2009.09.005

Refers to article:

  • Linking Article with Gastroenterology Ethnicity and Body Mass Index Are Associated With Hepatitis C Presentation and Progression , 17 August 2009

    Eric R. Kallwitz, Jennifer Layden–Almer, Manish Dhamija, Jamie Berkes, Grace Guzman, Rita Lepe, Scott J. Cotler, Thomas J. Layden
    Clinical Gastroenterology and Hepatology January 2010 (Vol. 8, Issue 1, Pages 72-78)

  • Reply , 04 November 2009

    Eric R. Kallwitz
    Clinical Gastroenterology and Hepatology January 2010 (Vol. 8, Issue 1, Page 97)

Clinical Gastroenterology and Hepatology
Volume 8, Issue 1 , Page 97, January 2010