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Graf C, Welzel T, Bogdanou D, Vermehren J, Beckel A, Bojunga J, Friedrich-Rust M, Dietz J, Kubesch A, Mondorf A, Fischer S, Lutz T, Stoffers P, Herrmann E, Poynard T, Zeuzem S, Dultz G, Mihm U. Hepatitis C Clearance by Direct-Acting Antivirals Impacts Glucose and Lipid Homeostasis. J Clin Med 2020; 9:E2702. [PMID: 32825571 PMCID: PMC7564474 DOI: 10.3390/jcm9092702] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infections are causally linked with metabolic comorbidities such as insulin resistance, hepatic steatosis, and dyslipidemia. However, the clinical impact of HCV eradication achieved by direct-acting antivirals (DAAs) on glucose and lipid homeostasis is still controversial. The study aimed to prospectively investigate whether antiviral therapy of HCV with DAAs alters glucose and lipid parameters. METHODS 50 patients with chronic HCV who were treated with DAAs were screened, and 49 were enrolled in the study. Biochemical and virological data, as well as noninvasive liver fibrosis parameters, were prospectively collected at baseline, at the end of treatment (EOT) and 12 and 24 weeks post-treatment. RESULTS 45 of 46 patients achieved sustained virologic response (SVR). The prevalence of insulin resistance (HOMA-IR) after HCV clearance was significantly lower, compared to baseline (5.3 ± 6.1 to 2.5 ± 1.9, p < 0.001), which is primarily attributable to a significant decrease of fasting insulin levels (18.9 ± 17.3 to 11.7 ± 8.7; p = 0.002). In contrast to that, HCV eradication resulted in a significant increase in cholesterol levels (total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein (HDL-C) levels) and Controlled Attenuated Score (CAP), although BMI did not significantly change over time (p = 0.95). Moreover, HOMA-IR correlated significantly with noninvasive liver fibrosis measurements at baseline und during follow-up (TE: r = 0.45; p = 0.003, pSWE: r = 0.35; p = 0.02, APRI: r = 0.44; p = 0.003, FIB-4: r = 0.41; p < 0.001). CONCLUSION Viral eradication following DAA therapy may have beneficial effects on glucose homeostasis, whereas lipid profile seems to be worsened.
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Affiliation(s)
- Christiana Graf
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Tania Welzel
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Dimitra Bogdanou
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Johannes Vermehren
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Anita Beckel
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Jörg Bojunga
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Mireen Friedrich-Rust
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Julia Dietz
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Alica Kubesch
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Antonia Mondorf
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Sarah Fischer
- Infektiologikum, Center for Infectious Diseases, 60596 Frankfurt, Germany; (S.F.); (T.L.)
| | - Thomas Lutz
- Infektiologikum, Center for Infectious Diseases, 60596 Frankfurt, Germany; (S.F.); (T.L.)
| | - Philipp Stoffers
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, 60596 Frankfurt, Germany;
| | | | - Stefan Zeuzem
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Georg Dultz
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
| | - Ulrike Mihm
- Department of Internal Medicine, University Hospital Frankfurt, 60596 Frankfurt, Germany; (T.W.); (D.B.); (J.V.); (A.B.); (J.B.); (M.F.-R.); (J.D.); (A.K.); (A.M.); (P.S.); (S.Z.); (G.D.); (U.M.)
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Diabetes Mellitus and Risk of Hepatic Fibrosis/Cirrhosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5308308. [PMID: 31080822 PMCID: PMC6475555 DOI: 10.1155/2019/5308308] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/27/2019] [Indexed: 02/06/2023]
Abstract
Development of cirrhosis is two- to threefold greater in patients with diabetes mellitus (DM), and in this setting, the prevalence of cirrhosis is surging worldwide. The present review served to examine clinical ties between DM and liver fibrosis and hepatic cirrhosis and explore related biologic mechanisms. Pathways contributing to various etiologies of cirrhosis in conjunction with DM were key investigative targets.
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Yen YH, Kuo FY, Kee KM, Chang KC, Tsai MC, Hu TH, Lu SN, Wang JH, Hung CH, Chen CH. Diabetes is associated with advanced fibrosis and fibrosis progression in non-genotype 3 chronic hepatitis C patients. Dig Liver Dis 2019; 51:142-148. [PMID: 30076015 DOI: 10.1016/j.dld.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is a risk factor of fibrosis progression in chronic hepatitis C (CHC). However, only one longitudinal study exploring whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in CHC patients has been conducted. AIMS We investigated whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients. METHODS A cohort consisting of 976 non-genotype 3 patients histologically proven to have CHC was studied. After excluding patients with biopsy-proven or ultrasound-identified cirrhosis, there were 684 patients without cirrhosis. All 684 patients underwent hepatocellular carcinoma surveillance using ultrasound every 6 months, with a median duration of follow-up evaluation of 102.4 months. During the follow-up period, 60 patients developed cirrhosis according to ultrasound findings. RESULTS For the subgroup of 684 patients without cirrhosis, Kaplan-Meier survival analyses showed no significantly different cumulative incidences of cirrhosis (log-rank test; P = 0.71) among the patients with diabetes as compared to those without. However, after making adjustments for age, gender, fibrosis, steatosis, sustained virological response status, and obesity using Cox's proportional hazard model, diabetes was found to be an independent predictor for cirrhosis (HR = 1.9; 95% CI = 1.05-3.43, P = 0.03). CONCLUSIONS Diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients.
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Affiliation(s)
- Yi-Hao Yen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fang-Ying Kuo
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kwong-Ming Kee
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chin Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Chao Tsai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Sheng-Nan Lu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Hung Hung
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Cholestatic liver (dys)function during sepsis and other critical illnesses. Intensive Care Med 2015; 42:16-27. [DOI: 10.1007/s00134-015-4054-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/06/2015] [Indexed: 01/05/2023]
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Dyal HK, Aguilar M, Bhuket T, Liu B, Holt EW, Torres S, Cheung R, Wong RJ. Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review. Dig Dis Sci 2015; 60:2813-24. [PMID: 26138651 DOI: 10.1007/s10620-015-3760-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rising rates of obesity, diabetes mellitus (DM), and nonalcoholic fatty liver disease among patients with chronic hepatitis C virus infection (HCV) may contribute to more rapid disease progression. AIM To evaluate the impact of concurrent obesity, DM, and steatosis on disease progression among HCV patients. METHODS A systematic review using structured keyword search of MEDLINE and EMBASE from January 1, 2001, to July 1, 2014, was performed to identify original articles evaluating the association of obesity, DM, and steatosis with advanced fibrosis (AF) among adults with chronic HCV. Studies involving HCV patients coinfected with human immunodeficiency virus, hepatitis B virus, hepatocellular carcinoma, or other chronic liver diseases were excluded. Quality assessment utilized Newcastle-Ottawa Scale. RESULTS Twenty cohort studies met inclusion criteria for analyses. Obesity was associated with increased risk of AF in seven studies with effect size ranging from OR 1.08 to 7.69. However, four studies did not demonstrate a significant association between obesity and AF. The presence of advanced steatosis among HCV patients was associated with increased risk of AF in 12 studies (OR 1.80-14.3). Concurrent DM was associated with increased risk of AF in six studies (OR 2.25-9.24). Thirteen studies were good quality, and seven studies were fair quality. CONCLUSION Concurrent DM and steatosis are associated with increased risk of AF among chronic HCV patients. The majority of studies demonstrated significant associations of obesity with AF. Targeted interventions to optimize management of obesity-related diseases among HCV patients may help mitigate HCV disease progression.
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Affiliation(s)
- Harleen K Dyal
- Division of Gastroenterology and Hepatology, Highland Hospital, Alameda Health System - Highland Hospital Campus, Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA,
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Ikeda K, Izumi N, Tanaka E, Yotsuyanagi H, Takahashi Y, Fukushima J, Kondo F, Fukusato T, Koike K, Hayashi N, Tsubouchi H, Kumada H. Discrimination of fibrotic staging of chronic hepatitis C using multiple fibrotic markers. Hepatol Res 2014; 44:1047-55. [PMID: 23941604 DOI: 10.1111/hepr.12221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/04/2013] [Accepted: 08/08/2013] [Indexed: 02/08/2023]
Abstract
AIM In order to evaluate and judge a fibrotic stage of patients with chronic hepatitis C, multivariate regression analysis was performed using multiple fibrotic markers. METHODS A total of 581 patients from eight hepatology units and institutes were diagnosed by needle biopsy as having chronic liver disease caused by hepatitis C virus. Twenty-three variables and their natural logarithmic transformation were employed in the multivariate analysis. RESULTS Multivariate regression analysis finally obtained the following function: z = 2.89 × ln (type IV collagen 7S) (ng/mL) - 0.011 × (platelet count) (×10(3) /mm(3) ) + 0.79 × ln (total bilirubin) (mg/dL) + 0.39 × ln (hyaluronic acid) (μg/L) - 1.87. Median values of the fibrotic score of F1 (n = 172), F2 (n = 80), F3 (n = 37) and F4 (n = 16) were calculated as 1.00, 1.45, 2.82 and 3.83, respectively. Multiple regression coefficient and coefficient of determination were 0.56 and 0.320, respectively. Validation with patient data from other institutions demonstrated good reproducibility of the fibrotic score for hepatitis C (FSC), showing 1.10 in F1 (n = 156), 2.35 in F2 (n = 73), 3.16 in F3 (n = 36) and 3.58 in F4 (n = 11). CONCLUSION A concise multiple regression function using four laboratory parameters successfully predicted pathological fibrotic stage of patients with hepatitis C virus infection.
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Affiliation(s)
- Kenji Ikeda
- Department of Hepatology, Toranomon Hospital; Okinaka Memorial Institute for Medical Research
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White DL, Richardson PA, Al-Saadi M, Fitzgerald SJ, Green L, Amaratunge C, Manvir A, El-Serag HB. Dietary history and physical activity and risk of advanced liver disease in veterans with chronic hepatitis C infection. Dig Dis Sci 2011; 56:1835-47. [PMID: 21188525 PMCID: PMC3383839 DOI: 10.1007/s10620-010-1505-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 11/17/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of customary diet and physical activity in development of advanced HCV-related liver disease is not well-established. METHODS We conducted a retrospective association study in 91 male veterans with PCR-confirmed chronic HCV and biopsy-determined hepatic pathology. Respondents completed the Block Food Frequency and the International Physical Activity questionnaires. We conducted three independent assessments based on hepatic pathology: fibrosis (advanced = F3-F4 vs. mild = F1-F2), inflammation (advanced = A2-A3 vs. mild = A1) and steatosis (advanced = S2-S3 vs. mild = S1). Each assessment compared estimated dietary intake and physical activity in veterans with advanced disease to that in analogous veterans with mild disease. Multivariate models adjusted for total calories, age, race/ethnicity, biopsy-to-survey lag-time, BMI, pack-years smoking, and current alcohol use. RESULTS Average veteran age was 52, with 48% African-American. Advanced fibrosis was more prevalent than advanced inflammation or steatosis (52.7% vs. 29.7% vs. 26.4%, respectively). The strongest multivariate association was the suggestive 14-fold significantly decreased advanced fibrosis risk with lowest dietary copper intake (OR = 0.07, 95% CI 0.01-0.60). Other suggestive associations included the 6.5-fold significantly increased advanced inflammation risk with lower vitamin E intake and 6.2-fold significantly increased advanced steatosis risk with lower riboflavin intake. The only physical activity associated with degree of hepatic pathology was a two-fold greater weekly MET-minutes walking in veterans with mild compared to advanced steatosis (P = 0.02). CONCLUSIONS Several dietary factors and walking may be associated with risk of advanced HCV-related liver disease in male veterans. However, given our modest sample size, our findings must be considered as provisional pending verification in larger prospective studies.
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Affiliation(s)
- Donna L. White
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2002 Holcombe Blvd, Houston, Texas 77030,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Peter A. Richardson
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Mukhtar Al-Saadi
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Stephanie J. Fitzgerald
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Linda Green
- Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Chami Amaratunge
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2002 Holcombe Blvd, Houston, Texas 77030
| | - Anand Manvir
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Hashem B. El-Serag
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2002 Holcombe Blvd, Houston, Texas 77030,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
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Abstract
The assessment of liver fibrosis provides useful information not only for diagnosis but also for therapeutic decisions. Although liver biopsy is the current gold standard for fibrosis assessment, it has some risks and limitations, including intra-observer and inter-observer variation, sampling error and variability. In recent years, many studies and great interest have been dedicated to the development of non-invasive tests to substitute a liver biopsy for fibrosis assessment and follow up. Advances in serological and radiological tests such as serum marker panels, transient elastography and their combinations can assess fibrosis accurately and reduce the need for a liver biopsy. But at present, all have failed to completely replace a liver biopsy because of their respective limitations and an imperfect gold standard used in current researches. The searching for an ideal surrogate is still in progress.
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Affiliation(s)
- Kun Zhou
- Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
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Kotlyar DS, Blonski W, Rustgi VK. Noninvasive monitoring of hepatitis C fibrosis progression. Clin Liver Dis 2008; 12:557-71, viii. [PMID: 18625428 DOI: 10.1016/j.cld.2008.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Noninvasive approaches in the diagnosis and monitoring of fibrosis are still evolving. Transient elastography is an inexpensive, rapid, and relatively accurate form of noninvasive monitoring, especially in severe fibrosis It is a nascent technology, however, and there is no clear indication that elastography is better than biopsy for less severe fibrosis. With improved resolution and longer term data, it may become a vital supplement. The combined use of transient elastography and biochemical markers seems to be the most promising noninvasive technique.
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Affiliation(s)
- David S Kotlyar
- University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Missiha SB, Ostrowski M, Heathcote EJ. Disease progression in chronic hepatitis C: modifiable and nonmodifiable factors. Gastroenterology 2008; 134:1699-714. [PMID: 18471548 DOI: 10.1053/j.gastro.2008.02.069] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 02/15/2008] [Accepted: 02/21/2008] [Indexed: 12/13/2022]
Abstract
The hepatic complications of chronic hepatitis C (CHC) usually occur only after progression to cirrhosis has taken place. Progression to cirrhosis, however, is extremely variable and depends on a broad set of host and viral factors that modify the rate at which fibrosis develops in a given individual. Despite their inherent limitations, studies of the natural history of CHC have identified several nonmodifiable factors associated with disease progression. These include age at acquisition of infection, sex, and race. More recent reports suggest important roles for host genetic polymorphisms and viral factors. Of greater immediate relevance to patients and their clinicians are the potentially modifiable factors, which include excessive alcohol consumption; smoking (tobacco and marijuana); insulin resistance; and coinfection with hepatitis B virus, human immunodeficiency virus type 1, or schistosomiasis. Unfortunately, to date, there are no reliable predictive models that can accurately estimate the risk of CHC disease progression.
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Affiliation(s)
- Sharif B Missiha
- Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Clinical significance of metabolic syndrome in the setting of chronic hepatitis C virus infection. Clin Gastroenterol Hepatol 2008; 6:584-9. [PMID: 18455698 DOI: 10.1016/j.cgh.2008.02.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The metabolic syndrome (MS) is a unique condition in which the underlying mechanism is related to insulin resistance. In hepatitis C virus (HCV) patients, insulin resistance has been linked to treatment failure. The aim of this study was to estimate the prevalence of MS in HCV patients undergoing antiviral therapy and to assess its predictive value in treatment outcome. METHODS All HCV treatment-naive patients who met the inclusion/exclusion criteria were studied (n = 228). MS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A logistic regression analysis was performed to study multivariable associations. The final model contained sex, ethnicity, body mass index, viral load, genotype, steatosis, fibrosis stage, and MS. RESULTS MS was present in 59 of 228 (26%) patients. Genotype 1 (P = .002) and presence of steatosis (P < .001) were found to be associated significantly with MS. Overall, sustained virologic response (SVR) was achieved in 108 of 228 (47%) patients. Male sex, non-Caucasian ethnicity, higher body mass index, high viral load, genotype 1, higher fibrosis stage, and MS were associated significantly with a lack of SVR. After adjusting for confounding variables, MS remained independently associated with a lack of SVR (P < .01). Specifically, subjects with MS were 3.8 (95% confidence interval, 1.4-10.5) times more likely to fail treatment than those without MS. CONCLUSIONS MS is seen frequently in patients with chronic HCV and is associated independently to lack of SVR. These findings support the concept that an aggressive intervention approach comprising lifestyle modification alone or in combination with drug treatment of the MS components may play an important role in improving antiviral responses in these patients.
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Segev DL, Sozio SM, Shin EJ, Nazarian SM, Nathan H, Thuluvath PJ, Montgomery RA, Cameron AM, Maley WR. Steroid avoidance in liver transplantation: meta-analysis and meta-regression of randomized trials. Liver Transpl 2008; 14:512-25. [PMID: 18383081 DOI: 10.1002/lt.21396] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Steroid use after liver transplantation (LT) has been associated with diabetes, hypertension, hyperlipidemia, obesity, and hepatitis C (HCV) recurrence. We performed meta-analysis and meta-regression of 30 publications representing 19 randomized trials that compared steroid-free with steroid-based immunosuppression (IS). There were no differences in death, graft loss, and infection. Steroid-free recipients demonstrated a trend toward reduced hypertension [relative risk (RR) 0.84, P = 0.08], and statistically significant decreases in cholesterol (standard mean difference -0.41, P < 0.001) and cytomegalovirus (RR 0.52, P = 0.001). In studies where steroids were replaced by another IS agent, the risks of diabetes (RR 0.29, P < 0.001), rejection (RR 0.68, P = 0.03), and severe rejection (RR 0.37, P = 0.001) were markedly lower in steroid-free arms. In studies in which steroids were not replaced, rejection rates were higher in steroid-free arms (RR 1.31, P = 0.02) and reduction of diabetes was attenuated (RR 0.74, P = 0.2). HCV recurrence was lower with steroid avoidance and, although no individual trial reached statistical significance, meta-analysis demonstrated this important effect (RR 0.90, P = 0.03). However, we emphasize the heterogeneity of trials performed to date and, as such, do not recommend basing clinical guidelines on our conclusions. We believe that a large, multicenter trial will better define the role of steroid-free regimens in LT.
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Affiliation(s)
- Dorry L Segev
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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