HEPATIC STEATOSIS IS ASSOCIATED WITH SEVERE FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS B

Background and aim: Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the characteristics of steatosis and IR in CHB patients, compared to CHC subjects, and to evaluate the potential association between these features and fibrosis severity. Material and methods: 170 consecutive patients with CHB (28 HBeAg positive, 128 HBeAg negative, and 14 HBeAg negative/anti-HDV positive), and 170 sex, age and BMI matched genotype 1 CHC patients were evaluated by liver biopsy and metabolic measurements, including IR, by the homeostasis model assessment (HOMA). Insulin resistance was defined if HOMA-IR>2.7. All biopsies were scored by one pathologist for staging and grading (Scheuer). Steatosis was considered significant if ≥10%. Results: The prevalence of significant steatosis was similar in both CHB and CHC patients (31% vs. 38%; p=0.14). IR rate was significantly higher in CHC than in CHB patients (42% vs. 26%; p=0.002). In CHB patients, at multivariate analysis, severe fibrosis (F3-F4) was independently associated with older age (OR 1.054,95%CI 1.007–1.103, p=0.02), low platelet levels (OR 0.984,95%CI 0.973–0.994, p=0.003), high GGT (OR 1.019,95%CI 1.001– 1.039, p=0.04), steatosis>10% (OR 3.601,95%CI 1.272–10.194, p=0.01), and moderate-severe necroinflammatory activity (OR 8.111,95%CI 1.884–34.925, p=0.005), regardless HBeAg status and HDV co-infection. Conclusions: CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate. Steatosis, is independently associated with severe fibrosis in CHB patients.