Serum HCV RNA levels correlate with histological liver damage and concur with steatosis in progression of chronic hepatitis C

Correlations of serum hepatitis C virus RNA and alanine transaminase with liver histopathological changes in patients with chronic hepatitis C

AIM: To investigate the relationship among serum hepatitis C virus RNA titer, alanine trans-aminase (ALT) and liver histological changes in patients with chronic hepatitis C.

METHODS: Fluorescent quantitative polymerase chain reaction was used to detect the level of serum HCV RNA in 132 patients with chronic hepatitis C; meanwhile, the levels of serum ALT were measured by biochemical instrument. Liver biopsy was performed in 30 of 132 patients, and histopathological changes were observed by HE staining under light microscope and scored according to the grades of liver necro-inflammatory activity and stages of liver fibrosis.

RESULTS: Of 132 cases, 98 (74.2%) were positive for HCV RNA (over 1.0×10⁶ copies/L), and 99 (75.0%) were with a higher ALT level. No significant correlation was noted between HCV RNA titer and ALT level (r = 0.40, P = 0.695), but a statistical relationship was noted between HCV RNA titer and the abnormal rate of ALT level (r = 1.00, P < 0.01). Liver biopsies indicated that HCV-RNA titer was not significantly correlated with the grades of liver necro-inflammatory activity (r = 0.50, P = 0.667) or the stage of liver fibrosis (r = 0.20, P = 0.80). The level of serum ALT was not markedly correlated with the stages of liver fibrosis (r = 0.40, P = 0.60), either, but statistically correlated with the grades of liver necro-inflammatory activity (r = 1.00, P < 0.01).

CONCLUSION: HCV RNA titer has no correlation with ALT level, and it can not reflect the degree of liver histological damage in patients with chronic hepatitis C. ALT level has no correlation with the stages of liver fibrosis, but it can reflect the grades of liver necro-inflammatory activity to some extent.

Liver disease in patients with diabetes mellitus

Diabetes mellitus is a growing health concern in our society. In addition to the well-known cardiovascular, renal, and ophthalmologic complications of diabetes, liver-related complications occur commonly and are often underrecognized. The ensuing article will review the relationship between diabetes mellitus and two common liver diseases: chronic hepatitis C and nonalcoholic fatty liver disease. The association with diabetes and cirrhosis, acute liver failure, hepatocellular carcinoma, and outcomes following orthotopic liver transplantation will also be discussed.

Steatosis and chronic hepatitis C virus infection: mechanisms and significance

Chronic hepatitis C (CHC) and steatosis are common entities that have the potential to interact synergistically and result in significant morbidity. Steatosis is frequently observed in CHC and seems to have a significant impact on the natural history of the disease with respect to development of fibrosis and reducing the virologic response to current therapy. Research efforts should continue to focus on delineating the complex viral and host interactions involved in the pathogenesis of hepatitis C virus (HCV)-related steatosis. This may provide novel future therapeutic strategies that may help modulate disease progression in relation to steatosis in HCV infection.

Suppression of hepatitis C virus replicon by TGF-beta

Hepatitis C virus (HCV) is one of the major causative agents of liver diseases, such as liver inflammation, fibrosis, cirrhosis, and hepatocellular carcinoma. Using an efficient HCV subgenomic replicon system, we demonstrate that transforming growth factor-beta (TGF-beta) suppresses viral RNA replication and protein expression from the HCV replicon. We further show that the anti-viral effect of this cytokine is associated with cellular growth arrest in a manner dependent on Smad signaling, not mitogen-activated protein kinase (MAPK) signaling. These results suggest a novel insight into the mechanisms of liver diseases caused by HCV.

Hepatitis C and steatosis

Steatosis is a common finding in patients with chronic hepatitis C (CHC) due to a combination of the direct steatogenic effect of hepatitis C virus (HCV) and the prevalence of metabolic risk factors in the HCV population. Steatosis is now established as a risk factor for disease progression in CHC and significantly impacts therapeutic response. Research efforts should continue to focus on defining the complex viral and host interactions involved in the pathogenesis of HCV-related steatosis so that future therapeutic strategies may be accurately and appropriately targeted.

Correlation of serum aminotransferases with HCV RNA levels and histological findings in patients with chronic hepatitis C: the role of serum aspartate transaminase in the evaluation of disease progression

OBJECTIVES

To investigate whether HCV RNA levels can be considered to be predictors of hepatocellular injury in patients with chronic hepatitis C, and whether aminotransferase levels are markers of liver damage.

METHODS

We performed a retrospective study on 112 patients with chronic hepatitis C. For each patient, we considered the baseline alanine aminotransferase (ALT) and serum aspartate transaminase (AST) levels, baseline HCV RNA, HCV genotype, histological evaluation and the mean aminotransferase levels measured in the 6 months following liver biopsy.

RESULTS

We found a statistically significant correlation between HCV RNA and aminotransferase levels measured during the follow-up (AST: r = 0.24, P = 0.01; ALT: r = 0.27, P = 0.004). We also observed a statistically significant correlation between HCV RNA levels and histological activity index (HAI) (r = 0.25, P = 0.008), as well as between the HAI and both baseline AST (r = 0.34, P = 0.0002) and ALT levels (r = 0.23, P = 0.01). These findings were confirmed by the mean aminotransferase values during follow-up. In the regression analysis, the fibrosis score was significantly and independently associated with baseline AST and ALT values.

CONCLUSIONS

Our results demonstrate a statistically significant correlation of aminotransferase values with the histological parameters, and an even stronger correlation with the AST values. Our study therefore suggests that aminotransferase values, especially AST, may correlate with liver damage.

Tumour necrosis factor alpha polymorphisms are not involved in the development of steatosis in chronic hepatitis C

AIM

To determine whether the different tumour necrosis factor alpha (TNF-alpha) promoter gene polymorphisms are involved in the development of steatosis in chronic hepatitis C.

PATIENTS AND METHODS

One hundred and thirty patients (89 men and 41 women; mean age 42.5 +/- 12.3 years) with chronic hepatitis C were included. Insulin resistance was measured according to the Homeostasis model assessment (HOMA IR). Serum leptin levels were also obtained and the body mass index and fat mass were calculated. Liver biopsy was carried out in all the patients, and steatosis was measured as one of four stages (0 to 3): stage 0, no steatosis; stage 1, < 25% of hepatocytes with steatosis; stage 2, 25-50%; and stage 3, > 50%. DNA samples were obtained in order to describe the polymorphisms at the TNF-alpha promoter gene position.

RESULTS

Fifty-nine of the 130 (45.38%) patients had different degrees of steatosis, while 71/130 (54.62%) were not steatosic. Six of the 59 (10.2%) patients with steatosis presented mutations at the -238 position of the TNF-alpha promoter region, while 5/71 (7.0%) patients without steatosis also showed mutations at this position (P=NS). Seventeen of the 59 (28.8%) steatosic patients showed a mutation at the -308 position, while 16/71 (22.5%) without steatosis also had this mutation (P=NS). Insulin resistance, beta cells reserve, insulin and leptin levels showed no differences between patients with or without mutations at the promoter region of the TNF-alpha gene.

CONCLUSIONS

TNF-alpha mutations do not seem to play any role in the development of steatosis in chronic hepatitis C.

Relationship between HCV RNA quantities and HCV genotypes and the outcome of patients with posttransfusion hepatitis C virus infection

AIM: To investigate the relationship between HCV RNA quantities and HCV genotypes and the outcome of patients with posttransfusion HCV infection in China.

METHODS: A total of 314 cases infected with HCV in Hebei province were enrolled. Their clinical manifestations were recorded and sera detected for liver enzymes, as well as virus markers. The B-type ultrasound was performed for examination of liver, spleen and gall bladder. In virus markers, HCV RNA was detected with fluorescence-quantitative polymerase-chain-reaction, HCV genotypes were determined by RFLP method.

RESULTS: After HCV infection, 132 (57.6%) of the 229 cases that were detected for HCV RNA still had detectable HCV RNA in their blood and the infection had cleared spontaneously in 97 cases (42.4%). None of 314 cases complained of any sign at present, and abnormal ALT was observed in 40.2%. Positive relation was observed between HCV RNA load and ALT (r = 0.346, P < 0.001). The serum HCV RNA load and ALT in patients with HCV-Ⅱ infection was significantly higher than that in patients with HCV-Ⅲ infection (P < 0.001). Male gender had higher chronic infection rate than female (infection rate at present, 66.7% vs 50.4%).

CONCLUSION: Higher spontaneous HCV clear rate after infection is observed. The clinical course of chronic HCV infection seems obscure and is often accompanied with mild to moderate elevated ALT/AST. The serum HCV RNA load and ALT in patients with HCV-Ⅱ infection is significantly higher than that in patients with HCV-Ⅲ infection. Male gender may have worse clinical outcomes.

Humoral immunity to immunodominant epitopes of Hepatitis C virus in individuals infected with genotypes 1a or 1b

Cellular immunity against multiple Hepatitis C virus (HCV) proteins is observed in patients acutely infected with HCV most of whom later resolve infection. We wished to assess humoral immunity in patients infected with HCV 1a or 1b genotypes in relation to viral load using plasma samples from HCV-infected individuals and a panel of peptides representing immunodominant epitopes of HCV structural and nonstructural proteins. Plasma from HCV 1a- and 1b-infected patients, respectively, were divided into two groups: patients with low viral load (<==100,000 RNA copies/ml) and patients with high viral load (>/=10,000,000 RNA copies/ml). The antigens were peptides representing epitopes from immunodominant regions of HCV core, E2, NS3, and NS4 proteins, as well as the hypervariable (HVR) epitopes in E2 from genotypes 1a and 1b. Individuals infected with HCV 1a evoked a stronger immune response to many immunodominant epitopes of HCV relative to individuals infected with HCV 1b. Moreover, among individuals infected with HCV 1a, those with low viral loads mounted significantly greater responses against these epitopes than did individuals with high viral loads. Our observations demonstrate that quantitatively different antibody responses are elicited against HCV depending on the genotype of infecting virus, and suggest that humoral immunity directed against multiple immunodominant epitopes in HCV 1a-infected individuals may help lower viral load in vivo.

Steatosis and fibrosis in patients with chronic hepatitis C

BACKGROUND

Steatosis is present on liver biopsy in approximately 50% of patients with hepatitis C; its association with stage of fibrosis has been reported, but its relation to other fibrosis associated factors is unknown.

AIM

To study the relation between steatosis and other histological features in patients with hepatitis C, and changes in steatosis with time.

METHODS

Cross sectional study: 233 routine liver biopsies from 219 patients with hepatitis C; hepatectomy specimens from 65 patients transplanted for hepatitis C cirrhosis. Longitudinal study: 41 patients with two biopsies and 10 patients with three biopsies performed over 2-8 years. Biopsies were scored by the Ishak scheme, and degree of steatosis assessed subjectively. Multivariate analysis was used to study the interaction of fibrosis associated factors. Changes in steatosis over time in individual patients were explored in the longitudinal study.

RESULTS

Steatosis was present in 50% of biopsies. It correlated strongly with fibrosis in non-cirrhotic samples, but declined in cirrhosis, and was unusual in transplant hepatectomy specimens. On multivariate analysis of non-cirrhotic biopsies, steatosis was associated with increasing patient age and remained significantly associated with fibrosis independent of portal inflammation and interface hepatitis. In the longitudinal study, steatosis persisted and increased over time, except in patients developing cirrhosis.

CONCLUSIONS

Steatosis is associated with fibrosis independently of necroinflammation, but declines in cirrhosis. It may represent a pathogenic pathway distinct from necroinflammatory activity in the generation of liver fibrosis, and should be included in the assessment of biopsies for clinical and research purposes.

Hepatitis C recurrence is not associated with allograft steatosis within the first year after liver transplantation

The natural history of allograft steatosis in hepatitis C (HCV)-infected patients after liver transplantation (LT) is poorly understood. The aim of our study was to determine the relationship of allograft steatosis to HCV recurrence after LT. All patients undergoing LT at our center from March 1998 to December 2001 were included in the study. Explanted liver tissue and liver biopsies performed at 1 week, 4 months, and 12 months were scored for degree of allograft steatosis (0-4), fibrosis (0-6), and modified histological activity index (0-18). One hundred sixty-seven HCV and 235 non-HCV-infected patients (control group) underwent LT. Of these patients, 122 HCV and 154 non-HCV patients had a viable graft at 1 year and were analyzed. Allograft steatosis was present in 40% of HCV patients at 4 months and 36% at 1 year. The incidence of allograft steatosis after LT was similar in HCV-infected and non-HCV-infected patients (P not significant). Age of the donor (P =.041), or higher recipient body mass index (BMI) at the time of LT (P =.015) or at 12 months after LT (P =.041) predicted a higher degree of allograft steatosis at 12 months in the HCV group. Degree of allograft steatosis was not associated with higher fibrosis or necroinflammatory score. In conclusion, there is a similar high incidence of allograft steatosis in HCV and non-HCV-infected patients after LT. A high BMI of the HCV-infected recipient is the best predictor for high degree of allograft steatosis after LT. Allograft steatosis does not predict the severity of HCV recurrence in the first 12 months after LT.

Factors associated with liver steatosis and fibrosis in chronic hepatitis C patients

Liver steatosis is a common finding in patients infected with hepatitis C virus (HCV). Host and viral factors have been associated with steatosis, but their relative contributions have not been clearly addressed. It has been suggested that steatosis plays a role in the progression of liver fibrosis.

AIMS

To assess: a) factors associated with steatosis in patients infected with hepatitis C virus; b) their impact on liver fibrosis.

PATIENTS AND METHODS

Three hundred and fourteen untreated patients were included. Lifetime alcohol consumption was estimated. Liver fibrosis, inflammation and necrosis were assessed using the METAVIR score. Body mass index (BMI) was determined. The scoring system for steatosis was as follows: 0, no steatosis; 1, less than 10%; 2, 10% to 30%; 3, 30% to 70%; 4, more than 70% of hepatocytes affected.

RESULTS

In univariate analysis, steatosis was associated with elevated BMI (P=0.001), excessive alcohol intake (P=0.005), genotype 3 (P<0.001) and moderate to severe histological activity (P=0.01). Multivariate analysis showed that steatosis correlated with two independent factors: genotype 3a (OR=60.7; 95% CI: 7.6-483.4) (P<0.001) and BMI (OR=4.86; 95% CI: 1.8-13.15) (P=0.002). In univariate analysis, severe fibrosis (F2-F3-F4) was associated with older age (P<10(-5)), male gender (P=0.001), disease duration (P<0.006), BMI (P<10(-4)), alcohol intake (P<10(-6)), severity of histological activity (P<10(-5)) and steatosis (P<10(-6)). In multivariate analysis, three independent factors were associated with severe fibrosis: disease duration > 10 years (OR=3.17; 95% CI: 0.65-15.4) (P=0.015), presence of steatosis (OR=3.17; 95% CI: 1-9.99) (P<0.049) and genotype 3a (OR=5.56; 95% CI: 1.4-22.1) (P=0.015).

CONCLUSION

In patients with chronic hepatitis C, steatosis is significantly associated with genotype 3 infection and high BMI. Steatosis is an independent risk factor associated with severe fibrosis. These results have major implications for the management of patients with chronic hepatitis C.

Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease

Nonalcoholic fatty liver disease (NAFLD) and hepatitis C virus (HCV)-related liver disease are common in the general population, but their concurrence is 2- to 3-fold higher than would be expected by chance alone. In patients with chronic HCV infection, steatosis is attributable to a variable combination of the mechanisms considered to play a role in the pathogenesis of NAFLD--insulin resistance in the obese and in the lean subject--along with a direct effect of HCV on hepatic lipid metabolism that leads to triglyceride accumulation through inhibition of export proteins that are required for very low density lipoprotein (VLDL) assembly and secretion. Accumulating evidence suggests that steatosis contributes to the progression of fibrosis in HCV-related disease in a pattern similar to that observed in NAFLD. Potential mechanisms of this effect include the increased sensitivity of steatotic livers to oxidative stress and cytokine-mediated injury. Steatosis-related hepatic insulin resistance may also play a role through the profibrogenic effects of the compensatory hyperinsulinemia and provides a potential explanation for the association between HCV and type 2 diabetes mellitus. Indeed, an appreciation of the importance of fat in HCV has recently led to trials of adjuvant therapy for HCV directed at steatosis-associated disease mechanisms, with encouraging results reported for various modalities, including weight loss and antioxidants. Future therapy should be aimed at exploiting the interactions of HCV with host insulin and lipid metabolism, particularly in nonresponders to standard antiviral schedules.

Steatosis accelerates fibrosis development over time in hepatitis C virus genotype 3 infected patients

BACKGROUND/AIMS

Steatosis is common in patients with hepatitis C virus (HCV) infection. Its influence on disease progression is only partially understood. The aim of this study was to evaluate the impact of steatosis on fibrosis progression over time in relation to HCV genotype.

METHODS

We retrospectively analyzed 98 patients who underwent dual liver biopsies prior to antiviral treatment. The median follow-up time was 5.8 years. Biopsy specimens were assessed for necroinflammatory activity, fibrosis and steatosis.

RESULTS

The prevalence and grade of steatosis were strongly associated with HCV genotype 3, independent of sex, age, body mass index and alcohol consumption. Progressive fibrosis was more prevalent in patients whose initial biopsy showed steatosis, an effect seen mainly in genotype 3 infected patients. Low-grade steatosis was observed in overweight patients, but high-grade steatosis was associated with genotype 3, independent of body mass index.

CONCLUSIONS

Our data confirm the association between HCV genotype 3 and steatosis. Furthermore, we showed that steatosis in genotype 3 infected patients is a risk factor for progression of fibrosis. Therefore, patients with genotype 3 and steatosis ought to be recommended for early therapeutic intervention.

Review of the effect of highly active antiretroviral therapy on hepatitis C virus (HCV) RNA levels in human immunodeficiency virus and HCV coinfection

The effect of anti-human immunodeficiency virus (HIV) treatment on hepatitis C virus (HCV) RNA levels in HIV-HCV-coinfected persons is uncertain. Although it is commonly believed that, with the initiation of HIV treatment, there may be an initial increase followed by a gradual decrease of HCV RNA levels to lower than those at pretreatment, the published studies evaluating this are of small and heterogeneous populations, are limited in follow-up, and have conflicting results. A prospective clinical trial of sufficient size and duration may help clarify this issue. This may be clinically relevant, because lower HCV RNA levels are a predictive factor for favorable response to HCV antiviral therapy.