First Report of Tobacco streak virus Infecting Kenaf (Hibiscus cannabinus) in India

The natural occurrence of Tobacco streak virus (TSV) in Hibiscus cannabinus was detected by enzyme-linked immunosorbent assay using an antiserum raised against TSV and reverse transcription polymerase chain reaction (PCR) using primers specific for the coat protein gene of the virus. Sequence analysis of the PCR products showed 99.6 and 99.5% of maximum identity at nucleotide and amino acid levels, respectively with TSV onion isolate from Kurnool (HM131490).This is the first report of the natural occurrence of TSV on kenaf in India.

Review article: herbal and dietary supplement hepatotoxicity

BACKGROUND

Herbal and dietary supplements are commonly used throughout the World. There is a tendency for underreporting their ingestion by patients and the magnitude of their use is underrecognised by Physicians. Herbal hepatotoxicity is not uncommonly encountered, but the precise incidence and manifestations have not been well characterised.

AIMS

To review the epidemiology, presentation and diagnosis of herbal hepatotoxicity. This review will mainly discuss single ingredients and complex mixtures of herbs marketed under a single label.

METHODS

A Medline search was undertaken to identify relevant literature using search terms including 'herbal', 'herbs', 'dietary supplement', 'liver injury', 'hepatitis' and 'hepatotoxicity'. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches.

RESULTS

The incidence rates of herbal hepatotoxicity are largely unknown. The clinical presentation and severity can be highly variable, ranging from mild hepatitis to acute hepatic failure requiring transplantation. Scoring systems for the causality assessment of drug-induced liver injury may be helpful, but have not been validated for herbal hepatotoxicity. Hepatotoxicity features of commonly used herbal products, such as Ayurvedic and Chinese herbs, black cohosh, chaparral, germander, greater celandine, green tea, Herbalife, Hydroxycut, kava, pennyroyal, pyrrolizidine alkaloids, skullcap, and usnic acid, have been individually reviewed. Furthermore, clinically significant herb-drug interactions are also discussed.

CONCLUSIONS

A number of herbal medicinal products are associated with a spectrum of hepatotoxicity events. Advances in the understanding of the pathogenesis and the risks involved are needed to improve herbal medicine safety.

Standardization of terminology of virological response in the treatment of chronic hepatitis C: panel recommendations

The treatment paradigm for hepatitis C virus (HCV) infection is at a critical point in its evolution. The addition of a protease inhibitor to peginterferon plus ribavirin has become the new standard-of-care treatment for most patients. Data from clinical trials of new antivirals have been difficult to interpret and compare, partly because of heterogeneity in trial design, and partly because of inconsistencies in terminology used to define viral responses and the populations evaluated. Present definitions of viral responses for treatment with peginterferon and ribavirin are insufficient for novel treatment paradigms. Further, categorization of prior patient treatment experience in clinical trials, particularly of nonresponders to prior therapy, is inconsistent. Existing terms and definitions must be updated, standardized and/or redefined for easier interpretation of data and effective communication among clinicians. A panel of experts in HCV infection treatment met on 3 December 2009. Goals of the panel were to evaluate terms and definitions used traditionally in treatment with peginterferon and ribavirin, to refine and clarify definitions of existing terms that have varying meanings and to propose new terms and definitions appropriate for novel treatment paradigms emerging with development of new agents. A number of recommendations were accepted unanimously by the panel. Adoption of these terms would improve communication among investigators, enhance comparability among clinical trials, facilitate development of therapeutic guidelines and provide a standardized terminology for use in clinical practice.

Response to tenofovir monotherapy in chronic hepatitis B patients with prior suboptimal response to entecavir

Both entecavir (ETV) and tenofovir (TDF) are potent antiviral agents for hepatitis B virus (HBV). Suboptimal response (SOR) following antiviral therapy is associated with an increased risk of subsequent treatment failure and viral resistance. It remains unclear whether switching to TDF is a reasonable approach in patients with SOR to ETV treatment. This study was aimed to determine how HBV patients with SOR to ETV respond to TDF monotherapy. Data of patients with SOR to ETV (failure to achieve >1 log(10) HBV-DNA reduction during the last 24 weeks of ETV treatment) who were switched to TDF monotherapy during 2005 and 2010 were reviewed. Treatment adherence was assessed by pill-count. Fourteen patients (2.9%) were identified from a total cohort of 482 ETV-treated patients. All 14 patients were Chinese and were infected with HBV genotype C (71%) or B (29%). Nine patients were men, and the median age was 41.5 years (19-64). Twelve were treatment naïve (one lamivudine- and one peginterferon-experienced patient); 85.7% were HBeAg positive. The median baseline HBV-DNA was 7.55 (5.30-9.40) log(10) copies/mL, and 57% had abnormal serum alanine aminotransferase (ALT) levels. Precore and/or basal core promoter mutations were detected in four patients, whereas no genotypic resistance was detected at baseline and before switching to TDF. The median duration of ETV treatment was 64.5 (26-126) weeks. The median HBV-DNA at the time of switching to TDF was 3.69 (3.00-4.90) log(10) copies/mL. The median HBV-DNA reduction from baseline and during the last 6-month observation period prior to switching to TDF was 4.04 (0.51-6.06) log(10) and 0.43 (-0.09-1.13) log(10) copies/mL, respectively. After the switching to TDF, all 14 patients (100%) achieved undetectable HBV-DNA and ALT normalization within a median duration of 30 weeks. In 12 patients who were HBeAg positive, HBeAg seroconversion was observed in two patients after TDF treatment of 75- and 84-weeks duration. There was no virological breakthrough observed after switching to TDF with a median follow-up period of 50 (24-160) weeks. TDF treatment was safe and well tolerated. In conclusion, suboptimal response to ETV is rare (approximately 3%). TDF monotherapy is safe and very effective in the management of HBV patients with SOR to ETV.

Waitlist survival of patients with primary sclerosing cholangitis in the model for end-stage liver disease era

The ability of the Model for End-Stage Liver Disease (MELD) score to capture the urgency of transplantation may not be generalizable to patients with primary sclerosing cholangitis (PSC) because these patients face unique risks of death or removal from the liver transplant waitlist due to disease-specific complications (eg, repeated bouts of bacterial cholangitis and cholangiocarcinoma). We constructed Cox regression models to determine whether disease-based differences exist in waitlist mortality before liver transplantation. We compared the times to death or withdrawal from the waitlist due to clinical deterioration among patients with or without PSC in the United States after the implementation of the MELD allocation score. Over an 8-year period, 14,073 non-PSC patients (20.5%) and 432 PSC patients (13.6%) died or were removed (P < 0.0001). The adjusted hazard ratio (HR) for PSC was 0.72 [95% confidence interval (CI) = 0.66-0.79], which indicated that these patients had a lower time-dependent risk of death or removal from the waitlist in comparison with patients without PSC. This difference was explained in part by the groups' different probabilities of portal hypertension complications at listing because adjustments for these intermediate endpoints moved the HR closer to the null (0.84, 95% CI = 0.74-0.97). In comparison with patients with other forms of end-stage liver disease, patients with PSC are less likely to die or be removed from the waitlist because of clinical deterioration; therefore, the prevailing practice in some centers and regions of preemptively referring PSC patients for living donor transplantation or exception points should be reconsidered.

Clinical features and natural history of hepatocellular adenomas: the impact of obesity

BACKGROUND

Hepatocellular adenoma is a benign tumour associated with bleeding and malignant transformation. Obesity has been linked to hepatic tumourigenesis.

AIM

To evaluate the presentation of hepatocellular adenoma in obesity, and the impact of obesity on the clinical course.

METHODS

Records of 60 consecutive patients (between 2005 and 2010) with a diagnosis of hepatocellular adenoma from a single tertiary centre were analysed.

RESULTS

Fifty six of 60 patients were women, median age was 36years, 75% had history of contraceptive use, 18% were overweight and 55% were obese (BMI ≥30kg/m(2) ). Majority (63%) were asymptomatic; seven patients presented with bleeding. Single (28%) and multiple adenomas (72%) were encountered; size ranged from 1 to 19.7cm. Obesity was more often associated with multiple adenomas (85% vs. 48%, P=0.005), bilobar distribution (67% vs. 33%, P=0.01), lower serum albumin (P=0.007) and co-morbidities of fatty liver (P=0.006), diabetes (P=0.003), hypertension (P=0.006) and dyslipidemia (P=0.03). During median follow-up of 2.6years, there were no instances of bleeding, malignant transformation or death. Thirty four patients underwent therapeutic intervention (17 surgical resection, nine transarterial embolization and eight both interventions sequentially). The rate of complete resection of adenoma(s) was significantly lower in obese patients (8% vs. 69%, P=0.004). In the 26 patients without intervention, tumour size progression was more frequently observed in obese patients (33% vs. 0%, P=0.05). Three of 15 obese patients (20%) lost ≥5% body weight and there was no progression in the liver lesions.

CONCLUSIONS

Obesity and features of metabolic syndrome were frequently observed in hepatocellular adenoma. Multiple and bilobar adenomas were more frequent in obese patients. Among patients who were conservatively managed, tumour progression was more often associated with obesity.

Synthesis of 3'-amino-3'-deoxyguanosine and 3'-amino-3'-deoxyxyloguanosine monophosphate HepDirect prodrugs from guanosine

The synthesis of 3'-amino-3'-deoxyguanosine and 3'-amino-3'-deoxyxyloguanosine monophosphate HepDirect prodrugs from guanosine is reported. Initial incorporation of N,N-dibenzylformamidino protection of the C2-amino of guanosine masked the reactivity of that group and simplified purification of subsequent analogues. The first key intermediate, 9-(2,5-bis-O-tert-butyldimethylsilyl-beta-D-ribofuranosyl)-2-N-(N,N-dibenzylformamidino)guanine (3a), was prepared in 60% yield after recycling of the undesired 3',5'-bis-O-protected byproduct (4a) by simple equilibration in methanol to a mixture of the two bis-O-protected compounds. Thus, protected, the 3'-position was manipulated to form the 3'-deoxyribo- or 3'-deoxyxylo-3'-azido derivatives (9 or 16, respectively). Further selective manipulations provided the cis-5'-monophosphate (3-chlorophenyl)-1,3-propanyl diester prodrugs (HepDirect prodrugs), 15 and 21. These HepDirect prodrugs were demonstrated to activate to their respective NTPs in rat hepatocytes.

Cowpea (Vigna unguiculata [L.] Walp.) genotypes response to multiple abiotic stresses

The carbon dioxide concentration [CO(2)], temperature and ultraviolet B radiation (UVB) are concomitant factors projected to change in the future environment, and their possible interactions are of significant interest to agriculture. The objectives of this study were to evaluate interactive effects of atmospheric [CO(2)], temperature, and UVB radiation on growth, physiology and reproduction of cowpea genotypes and to identify genotypic tolerance to multiple stressors. Six cowpea (Vigna unguiculata [L.] Walp.) genotypes differing in their sites of origin were grown in sunlit, controlled environment chambers. The treatments consisted of two levels each of atmospheric [CO(2)] (360 and 720 micromol mol(-1)), UVB [0 and 10 kJ m(-2)d(-1)) and temperatures [30/22 and 38/30 degrees C] from 8 days after emergence to maturity. The ameliorative effects of elevated [CO(2)] on increased UVB radiation and temperature effects were observed for most of the vegetative and photosynthetic traits but not for pollen production, pollen viability and yield attributes. The combined stress response index (C-TSRI) derived from vegetative (V-TSRI) and reproductive (R-TSRI) parameters revealed that the genotypes responded negatively with varying magnitude of responses to the stressors. Additionally, in response to multiple abiotic stresses, the vegetative traits diverged from that of reproductive traits, as deduced from the positive V-TSRI and negative R-TSRI observed in most of the genotypes and poor correlation between these two processes. The UVB in combination with increased temperature caused the greatest damage to cowpea vegetative growth and reproductive potential. The damaging effects of high temperature on seed yield was not ameliorated by elevated [CO(2)]. The identified tolerant genotypes and groups of plant attributes could be used to develop genotypes with multiple abiotic stress tolerance.

Fructose-1,6-bisphosphatase Inhibitors. 2. Design, synthesis, and structure-activity relationship of a series of phosphonic acid containing benzimidazoles that function as 5'-adenosinemonophosphate (AMP) mimics

Efforts to enhance the inhibitory potency of the initial purine series of fructose-1,6-bisphosphatase (FBPase) inhibitors led to the discovery of a series of benzimidazole analogues with human FBPase IC(50)s < 100 nM. Inhibitor 4.4 emerged as a lead compound based on its potent inhibition of human liver FBPase (IC(50) = 55 nM) and significant glucose lowering in normal fasted rats. Intravenous administration of 4.4 to Zucker diabetic fatty rats led to rapid and robust glucose lowering, thereby providing the first evidence that FBPase inhibitors could improve glycemia in animal models of type 2 diabetes.

Peginterferon alpha-2a (40 kDa) and ribavirin: comparable rates of sustained virological response in sub-sets of older and younger HCV genotype 1 patients

The average age of patients initiating therapy for HCV is increasing, with older patients exhibiting lower responses to therapy than younger patients. Identification of those older patients likely to respond needs to be addressed. Using data from 569 genotype-1 patients enrolled in two phase III studies (NV15801/NV15942) randomized to peginterferon alpha-2a (40 KDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48-weeks, we investigated factors associated with sustained virological response (SVR; undetectable HCV-RNA 24-weeks post-treatment) in patients >50 years. SVR rates among patients <or=50 was greater than those >50 years (52%vs 39%; P = 0.0073). Older patients with a rapid virological response (RVR; undetectable HCV-RNA at treatment week 4) or complete early virological response (cEVR; detectable HCV-RNA at week 4 but HCV-RNA <50 IU/mL at week-12) demonstrated high SVR rates (83% and 61% respectively). Older patients had lower cumulative peginterferon alpha-2a exposure and significantly lower cumulative ribavirin exposure (252 g vs 304 g in younger patients; P < 0.0001). Higher relapse rates were observed in older patients (41%vs 25%; P = 0.0042). Cumulative drug exposure and achievement of RVR or cEVR were significantly predictive of SVR by multiple logistic regression analysis in patients >50 years. Other baseline characteristics predictive of SVR in those >50 years of age were lower baseline HCV-RNA level (P = 0.0067), higher ALT-ratio (P = 0.0113) and absence of cirrhosis (P = 0.0482). Response rates were high among patients >50 years without cirrhosis who maintained adequate drug exposure and those achieving an RVR or cEVR. More frequent dose modifications of ribavirin in those >50 years likely contributed to the observed higher relapse rates.

Development of indices to predict phosphorus release from wetland soils

The U.S. Environmental Protection Agency created the Clean Water Action Plan to develop nutrient criteria for four water body types: lakes and reservoirs, rivers and streams, estuaries, and wetlands. Significant progress has been made in open water systems. However, only areas in and around the Florida Everglades have had numeric nutrient criteria set, due to the complexity, heterogeneity, and limited information available for wetlands. Our objective was to evaluate various soil tests to predict significant P release potential of soil in wetlands. A total of 630 surface soil samples (0-10 cm) were collected for this study from four southeastern states: Florida, Alabama, Georgia, and South Carolina. Soil samples were collected from the center of wetlands, the edge of the wetlands, and from adjacent uplands. The phosphorus saturation ratios (PSR), calculated using P, Fe, and Al molar concentrations from Mehlich 1 (M1-PSR), Mehlich 3 (M3-PSR), and oxalate (Ox-PSR) extractions and the amount of P extracted by different extractants were used to predict P loss potential from a soil. Total phosphorus (TP) concentration in wetland soils, estimated as the 75th percentile of the distribution of least impacted wetland soils as an example, was approximately 550 mg kg(-1). Based on this reference background condition, procedures for obtaining threshold values for P release to the surrounding water bodies were developed and threshold values calculated: M1-P = 24 mg kg(-1), M3-P = 44 mg kg(-1), Ox-PSR = 0.079, M1-PSR = 0.101, and M3-PSR = 0.067.

Inhibition of Aspergillus flavus colonization and aflatoxin (AfB1) in peanut by methyleugenol

Methyleugenol is naturally occurring substance in oils and fruits and in various foods as flavoring agent. Effect of this methyleugenol in inhibiting A. flavus colonization and aflatoxin production on peanut pods and kernels has been studied. Spray of methyleugenol (0.5%) on peanut pods and kernels checked the colonization of A. flavus and aflatoxin synthesis. This chemical can be used as both prophylactic or post infection spray on peanut pods before storage. It is the first report on the inhibition of A. flavus by methyleugenol on peanut.

Response of bahiagrass carbon assimilation and photosystem activity to below optimum temperatures

Photosynthesis and growth of tropical grasses are sensitive to cool season temperatures but information on the responsive mechanisms is limited in many species including bahiagrass (Paspalum notatum Flueggé). Therefore, an experiment was conducted in sunlit, controlled environment chambers to determine the effect of below optimum temperatures on leaf net photosynthesis (A) and chlorophyll fluorescence (F) and response to internal [CO₂] (C_i) and photosynthetic photon flux density (PPFD) of A and F of bahiagrass. Five day/night temperatures of 14/6, 18/10, 22/14, 26/18 and 30/22°C were imposed from 55 to 100 days after transplanting for plants grown initially for 55 days at 30/22°C. Leaf A and F were measured from 1000 to 1400 hours between -1 to 35 days after imposing temperature treatments. Leaf A-F/C_i and A-F/PPFD response curves were measured between 11 and 20 days after start of temperature treatments. After 35 days of treatment, the cold acclimation response of leaf A was assessed by lowering temperature in all treatments to 6°C and measuring A and F for a 3-day period. Repeated-measures analysis showed significant effects of time, temperature and time × temperature. The reduction of A on the first day of cold shock was 64, 37, 61, 64 and 81% in plants previously grown at 14, 18, 22, 26 and 30°C, respectively, which indicates acclimation at 18°C. Below optimum temperature significantly lowered CO₂-saturated net photosynthesis (A_sat), carboxylation efficiency (CE) and electron transport rate (ETR) derived from A-F/C_i curves. Below optimum temperature also lowered light-saturated photosynthesis (A_max), Rd and ETR derived from A-F/PPFD curves. The relationship between φ_CO2 and φ_PSII showed that bahiagrass A was more sensitive than electron transport at below optimum temperatures, which may be associated with increased CO₂ leakage and over-cycling of C₄ acid cycle. The leaf-level photosynthesis parameters and their response functions will also help to improve algorithms for simulating forage growth under variable temperature conditions.

Review article: the evaluation of solitary liver masses

BACKGROUND

The increasing use of imaging modalities has led to the detection of more liver masses. The differential diagnosis of a focal liver mass includes a host of benign as well as malignant conditions.

AIM

To provide a comprehensive review on the commonly encountered liver masses, and to help guide an approach to their evaluation and management.

METHODS

Pertinent literature that was identified through PubMed search and senior author's experience formed the basis of this review.

RESULTS

While most incidentally noted liver masses are benign, it may be difficult to differentiate them from those that are malignant. Furthermore, some benign lesions have malignant potential. Certain lesions such as focal nodular hyperplasia, haemangiomas and focal steatosis are often distinctly diagnosed by an imaging modality alone. The less frequently encountered hepatic adenomas are diagnosed radiologically in those with the appropriate clinical background and the absence of radiological features to suggest haemangioma or focal nodular hyperplasia.

CONCLUSIONS

A reasonable approach to the diagnosis, follow-up and management of liver masses is based on a rudimentary knowledge of their presentation, associated clinical and laboratory features, natural history and available treatment options. Most often, the so called 'incidentalomas' are benign and require patient reassurance.

Hepatocellular carcinoma in long-term sustained virological responders following antiviral combination therapy for chronic hepatitis C

Antiviral treatment results in a sustained virologic response (SVR) in 50-75% of patients with chronic hepatitis C. Long-term follow up studies have observed ongoing SVR in the overwhelming majority of them. Thus chronic hepatitis C is considered 'cured' if an SVR is achieved. Consequently, it is expected that in sustained virologic responders long-term complications of hepatatic C virus (HCV) related chronic liver disease including hepatocellular carcinoma are eliminated or have a decreased incidence. We report on five patients (three from Austria, two from USA) who developed hepatocellular carcinoma during follow up (3-6 years) after achieving SVR. During follow up and at diagnosis all were HCV-RNA neg. None of the patients had other liver diseases. One patient presented with bilateral adrenal metastasis, the remaining four with large hepatic tumours. Three patients were noncirrhotic at the start of treatment at the time of tumour diagnosis. Successful antiviral treatment in HCV patients does not prevent development of hepatocellular carcinoma even in non-cirrhotic livers. Long-term follow up of patients with SVR is mandatory and should include surveillance for hepatocellular carcinoma.

Assessing genotypic variability of cowpea (Vigna unguiculata [L.] Walp.) to current and projected ultraviolet-B radiation

The current and projected terrestrial ultraviolet-B (UV-B) radiation affects growth and reproductive potential of many crops. Cowpea (Vigna unguiculata [L.] Walp.), mostly grown in tropical and sub-tropical regions may already be experiencing critical doses of UV-B radiation due to a thinner ozone column in those regions. Better understanding of genotypic variability to UV-B radiation is a prerequisite in developing genotypes tolerant to current and projected changes in UV-B radiation. An experiment was conducted in sunlit, controlled environment chambers to evaluate the sensitivity of cowpea genotypes to a range of UV-B radiation levels. Six cowpea genotypes [Prima, California Blackeye (CB)-5, CB-27, CB-46, Mississippi Pinkeye (MPE) and UCR-193], representing origin of different geographical locations, were grown at 30/22 degrees C day/night temperature from seeding to maturity. Four biologically effective ultraviolet-B radiation treatments of 0 (control), 5, 10, and 15 kJ m(-2)d(-1) were imposed from eight days after emergence to maturity. Significant genotypic variability was observed for UV-B responsiveness of eighteen plant attributes measured. The magnitude of the sensitivity to UV-B radiation also varied among cowpea genotypes. Plants from all genotypes grown in elevated UV-B radiation were significantly shorter in stem and flower lengths and exhibited lower seed yields compared to the plants grown under control conditions. Most of the vegetative parameters, in general, showed a positive response to UV-B, whereas the reproductive parameters exhibited a negative response showing the importance of reproductive characters in determining tolerance of cultivars to UV-B radiation. However, all cultivars, except MPE, behaved negatively to UV-B when a combined response index was derived across parameters and UV-B levels. Based on the combined total stress response index (C-TSRI) calculated as sum of individual vegetative, physiological and reproductive component responses over the UV-B treatments, the genotypes were classified as tolerant (MPE), intermediate (CB-5, CB-46 and UCR-193) and sensitive (CB-27 and Prima) to UV-B radiation. The differences in sensitivity among the cowpea genotypes emphasize the need for selecting or developing genotypes with tolerance to current and projected UV-B radiation.

The response of benthic foraminifera to various pollution sources: a study from Nellore Coast, East Coast of India

A study of benthic foraminiferal species was carried out along Nellore Coast of South India. Analysis of surfacial sediment samples from the study area shows enrichment in heavy metals (Cr, Cu, Pb and Zn). The environment has become so lethal to foraminifera that minimal species number (4-7) can currently preserved in living condition in a depth less than 5-fth contour from coast. Samples from outfalls which receive only agricultural and aquacultural drainage water show heavy metal concentrations slightly higher to natural baseline levels, and yielding, living foraminifera (10-15). The frequent occurrence of deformed and abnormal specimens in Industrial outfalls, comparable to aquacultural and agricultural outlets reveal that (a) benthic foraminifera are more sensitive to industrial wastes containing heavy metals, (b) agricultural and aquacultural wastes do not significantly harm benthic foraminifera, and (c) morphological abnormalities of the foraminiferal tests depend upon the nature of the pollutant.

Hepatic steatosis in chronic hepatitis C: baseline host and viral characteristics and influence on response to therapy with peginterferon alpha-2a plus ribavirin

Hepatic steatosis is common in hepatitis C virus (HCV)-infected patients and may be associated with the metabolic syndrome. We studied steatosis in patients treated with peginterferonalpha-2a plus ribavirin. Forty-five of 207 patients (22%) had >5% hepatic steatosis at baseline. Significantly more patients with steatosis than without were HCV genotype 3 (51%vs 14%; P < 0.0001) had higher HCV-RNA (P = 0.0045), body weight (P = 0.0176), body mass index (BMI, P = 0.0352) and serum triglycerides (TG) (P = 0.0364), hypertriglyceridaemia (P = 0.0009), elevated blood pressure/history of hypertension (P = 0.0229) and lower cholesterol (P = 0.0009). Significant steatosis predictors were genotype 3 (OR 9.04, 95% CI 3.85-21.21, P < 0.0001), HCV-RNA (OR 2.96, 1.49-5.88, P = 0.0019) and triglycerides (OR 1.06, 1.02-1.11, P = 0.0071). In genotype 3 patients, HCV-RNA was the only significant predictor (OR 11.15, 2.60-47.81, P = 0.0012). In non-genotype 3 patients, hypertriglyceridaemia was the only significant predictor (OR 1.07, 1.02-1.12, P = 0.0041). 134 of 207 patients (65%) achieved an sustained virological response (SVR) with peginterferon alpha-2a plus ribavirin, similar to the overall response rate. In genotype 3 patients with an SVR, steatosis decreased from 48% to 13% (baseline to end-point). No change was seen in the steatosis rate in non-genotype 3 patients with an SVR. This large and comprehensive analysis of a large data base from a multinational trial further adds to the observations that chronic HCV is associated with hepatic steatosis in approximately a fifth of patients. Further, features of the metabolic syndrome are associated with hepatic steatosis in most of these patients. Steatosis is significantly more common in genotype 3 compared with other genotypes, and in these patients, an SVR is associated with steatosis clearance.