Liver Health Could Indicate Hepatosteatosis in Patients with HCV

A common liver health measurement could be a strong indicator of risk of hepatosteatosis in patients with chronic hepatitis C virus (HCV) infection, a Taiwanese study in BMJ Open suggests.

According to the research, Southern Taiwan is an HCV hyperendemic area with a high prevalence of up to 57.9%. Earlier research has shown that patients with HCV have significantly higher levels of insulin resistance compared with uninfected controls and a higher incidence of diabetes, even compared with hepatitis B virus (HBV)-infected controls. Hepatocyte steatosis, defined as the accumulation of fat droplets and an increased level of intrahepatic triglycerides (TGs) in hepatocytes, is the main cause of insulin resistance.

Non-alcoholic fatty liver disease (NAFLD), which affects approximately 20 to 30% of people worldwide, has been reported to contribute to insulin resistance, as well as type 2 diabetes and other cardiovascular events. NAFLD not only can progress to severe liver disease, including hepatosteatosis, fibrosis, and hepatocellular cancer, it also leads to a lower likelihood of achieving sustained virological response after antiviral therapy for HCV. However, the study authors noted, “Most cases of NAFLD are discovered incidentally, and the majority of NAFLD cases ‘silently’ coexist with asymptomatic hepatitis C.”

The study aimed to determine the impact of the alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio on systemic and hepatic inflammatory pathogenesis in patients with HCV infection and steatosis. Study participants were selected from a community-based group in rural Taiwan where there is a high prevalence of HCV infection from December 2012 to September 2013. More than 1,300 participants (580 males and 774 females) who me the study criteria were evaluated.

The participants with NAFLD had significantly higher levels of ALT/AST ratio, fasting glucose, triglyceride and systolic/diastolic blood pressure than non-NAFLD participants. The association between NAFLD and ALT/AST was significant even when adjusting for metabolic syndrome. In patients with a high degree of NAFLD, the ALT/AST ratio was still a significant predictor for hepatosteatosis.

One major limitation of the study was the sole use of ultrasound to diagnose fatty liver in those patients participating in the study. The researchers acknowledge that, while liver biopsy is the optimal method for diagnosing NAFLD, the procedure is costly and complex, and thus unlikely to be used in population-based studies.

“It has been estimated that approximately 20% of individuals infected with HCV are obese, and that obesity in these individuals is associated with steatosis and the progression of fibrosis,” the authors observed. They also found that a higher uric acid level was associated with a high degree of steatosis, suggesting that a complex of metabolic and inflammatory processes may be involved in hepatosteatosis.

“To the best of our knowledge, this is the first study to show that hepatic inflammation, as measured by the serum aminotransferase ratio, and metabolic factors are associated with hepatosteatosis in patients with chronic hepatitis C infection,” the researchers concluded. “The ability to identify individuals with hepatosteatosis may help healthcare professionals to implement lifestyle interventions.”