INSULIN RESISTANCE, STEATOSIS AND PROGRESSION OF FIBROSIS IN PATIENTS WITH GENOTYPE 1 CHRONIC HEPATITIS C

Background and aim: Insulin resistance (IR) and steatosis have been associated with fibrosis severity in chronic hepatitis C (CHC), but only few studies investigate their role as predictors of disease evolution. We aimed to assess in patients with CHC if IR and steatosis are linked to progression of fibrosis over time. Material and methods: 86 consecutive G1 HCV infected patients with two paired liver biopsies over a period 67±30 months (range, 13-135), were evaluated at baseline by anthropometric and metabolic measurements, including IR (IR= HOMA-IR >2.7). All biopsies were scored by one pathologist for staging and grading (Scheuer). Steatosis was considered significant if =10. Results: At the first liver biopsy the stage of fibrosis was F0, F1, F2 and F3, in 11, 38, 28 and 9 patients respectively. Steatosis =10% was found in 34 patients (39.5%), and IR in 33 patients (38.4%). Fibrosis progression, defined as at least one point increase in fibrosis score, was observed in 47 patients (54.6%). IR (OR 4.126, 95%CI 1.314–12.956, p=0.01), steatosis=10% (OR 3.148,95%CI 1.065–9.303, p=0.03), and moderate-severe necroinflammatory activAbstracts / Digestive and Liver Disease 42S (2010) S61–S192 S77 ity (OR 3.117, 95%CI 1.045–9.300, p=0.04) were independently associated with fibrosis progression by multivariate logistic regression analysis. Conclusions: Metabolic factors, namely IR and steatosis are major determinants of progression of fibrosis in subjects with mild G1 CHC, especially when significant necroinflammation is also present on biopsy.