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About 15% of people in the general population have liver steatosis. In patients with chronic hepatitis C there may be mild steatosis, which correlates with body mass index (BMI) and may be metabolic in origin, or moderate to severe steatosis that is more likely to be caused directly by the virus, especially genotype 3 virus. Steatosis may lead directly to progression of liver disease or it may add to the effect of other factors. Researchers in Switzerland and Italy have emphasised the importance of viral genotype.
The study included 755 patients with histologically and virologically proved chronic hepatitis C due to HCV genotypes 1–4 (178 with genotype 3, genotypes 5 and 6 excluded). Histology showed steatosis in 315 patients and fibrosis in 605 (187 with cirrhosis). On multivariate logistic regression analysis the factors independently associated with steatosis were fibrosis, viral genotype 3, BMI, current alcohol abuse, and age. Fibrosis was independently associated with liver disease activity score (Metavir score), age, steatosis, past alcohol abuse for more than five years, and BMI. In patients infected with virus of genotype 3 steatosis was associated with only Metavir score and fibrosis was associated with steatosis. In patients with HCV infection due to other genotypes steatosis was associated with continuing alcohol abuse and age, and fibrosis with past alcohol abuse and marginally with diabetes.
Among patients with chronic hepatitis C hepatic steatosis is associated with fibrosis only when the infection is with genotype 3 virus. Patients with steatosis and genotype 3 virus infection should be offered antiviral treatment irrespective of other considerations. When infection is with other genotypes of the virus abstinence from alcohol and weight control are also important.