Westin J, Lagging M, Dhillon A P, Norkrans G, Romero A I, Pawlotsky J-M, Zeuzem S, Schalm S W, Verheij-Hart E, Negro F, Missale G, Neumann A U, Hellstrand K
Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden.
J Viral Hepat. 2007 Jan;14(1):29-35. doi: 10.1111/j.1365-2893.2006.00777.x.
Liver steatosis is highly prevalent in chronic hepatitis C virus (HCV) infection, especially in patients infected with genotype 3 virus, but its significance for the outcome of antiviral treatment is not fully understood. We have monitored steatosis in liver biopsies from 231 patients with chronic HCV infection who received pegylated recombinant interferon-alpha and ribavirin in a phase III study (DITTO trial). The degree of steatosis, along with relevant metabolic parameters, was correlated with the early disappearance of virus and with the final outcome of treatment. Our data suggest that the presence of steatosis impairs the early reduction of viral load during treatment in patients infected with HCV genotype 3 and non-3. Steatosis negatively affected the final outcome of treatment mainly in patients infected with HCV genotype non-3 virus. Based on these findings, we propose that interventions aiming at reducing hepatic steatosis prior to the onset of antiviral therapy may be of benefit to patients infected with HCV of the non-3 genotypes. Patients infected with genotype 3, on the other hand, should be offered early antiviral treatment.
肝脂肪变性在慢性丙型肝炎病毒（HCV）感染中非常普遍，尤其是在感染3型病毒的患者中，但它对抗病毒治疗结果的意义尚未完全明确。在一项III期研究（DITTO试验）中，我们监测了231例接受聚乙二醇化重组干扰素-α和利巴韦林治疗的慢性HCV感染患者肝活检中的脂肪变性情况。脂肪变性程度以及相关代谢参数与病毒的早期清除和治疗的最终结果相关。我们的数据表明，脂肪变性的存在会损害HCV 3型和非3型感染患者治疗期间病毒载量的早期降低。脂肪变性主要对感染非3型HCV病毒的患者的治疗最终结果产生负面影响。基于这些发现，我们建议在抗病毒治疗开始前旨在减少肝脂肪变性的干预措施可能对非3型HCV感染患者有益。另一方面，感染3型的患者应尽早接受抗病毒治疗。
