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

Reply

published online 04 November 2009.

Article Outline

 

Thank you for your interest in our work. As your correspondence mentions, the metabolic syndrome impacts the disease course of the hepatitis C virus (HCV) in multiple ways. When the histologic lesion of both nonalcoholic steatohepatitis and chronic HCV occurred in the same biopsy, fibrosis tended to be more advanced than those with HCV and bland steatosis.1 In addition, the effect that HCV exerts on metabolic disease is important. This effect recently was highlighted by a study that associated HCV with both peripheral and hepatic insulin resistance in chronically infected individuals without any components of the metabolic syndrome.2 Clearly, the relationship between chronic HCV and the metabolic syndrome is complex, and the end result appears to be more significant liver disease.

It is likely that further examination of important disparities occurring in diverse populations with HCV will shed further light on the impact of metabolic disease on hepatic disease progression. As an example, recent research in fatty liver disease highlighted the importance of ethnic differences in intraperitoneal fat distribution,3 which also could impact on HCV.

Multidisciplinary treatment, as in metabolic liver disease,4 also could impact HCV natural history and treatment outcomes favorably. Although further data are needed to examine the effects of lifestyle modifications on HCV, we agree that HCV needs to be viewed in context of the interplay between the virus and metabolic factors.

Back to Article Outline

References 

  1. Bedossa P, Moucari R, Chelbi E, et al. Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: a prospective study. Hepatology. 2007;46:380–387
  2. Vanni E, Abate ML, Gentilcore E, et al. Sites and mechanisms of insulin resistance in nonobese, nondiabetic patients with chronic hepatitis C. Hepatology. 2009;50:697–706
  3. Guerrero R, Vega GL, Grundy SM, et al. Ethnic differences in hepatic steatosis: an insulin resistance paradox?. Hepatology. 2009;49:791–801
  4. Bellentani S, Dalle Grave R, Suppini A, et al. Behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary approach. Hepatology. 2008;47:746–754

 Conflicts of interest The authors disclose no conflicts.

PII: S1542-3565(09)01133-1

doi:10.1016/j.cgh.2009.10.030

Refers to article:

  • Hepatitis C Virus and Nonalcoholic Fatty Liver Disease: Similar Risk Factors for Necroinflammation, Fibrosis, and Cirrhosis , 18 September 2009

    Donatella Comparcola, Anna Alisi, Valerio Nobili
    Clinical Gastroenterology and Hepatology January 2010 (Vol. 8, Issue 1, Page 97)

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