Serum lipid profile and chronic hepatitis C virus
Authors: Tugrul Purnak, Cumali Efe, Yavuz Beyazit, Ersan Ozaslan
Journal: Hepatology (2010)

We read with great interest the article by Harrison et al.1 regarding the predictive role of serum lipids in the standard treatment of chronic viral hepatitis C with pegylated interferon and ribavirin. We think that the clinical implications extracted from this study deserve further examination. First, alcohol use in patients with chronic hepatitis C has been associated with decreased rates of sustained virological response in some studies even though the exact amount of alcohol consumption and the exact nature of the habit (current or past alcohol use) have remained unknown.2-4 In Harrison et al.1's article,1 we did not notice any information about the alcohol consumption of the study participants. Second, according to their study,1 low high-density lipoprotein (HDL) levels and elevated low-density lipoprotein (LDL) levels are positive prognostic factors for a treatment response in patients with chronic hepatitis C. However, to the best of our knowledge, smoking and exercise are the main determinants of the HDL level. Although the smoking status of the study participants was shown in the baseline demographic data, the exercise status of the patients was not provided, and this may have strikingly affected the results. Some studies have suggested that interleukin-28B has a role in the treatment response differences among patients with chronic hepatitis C undergoing interferon therapy. Various ethnic groups express this gene in different ways. This is also a predictive factor for the treatment response and may explain why some groups of the same ethnic background respond to treatment better in comparison with other ethnic groups; however, additional studies are needed to confirm its importance.5-10 On the other hand, before we make a judgment about the results of the study, we should consider that the treatment response differences may be the result of an interleukin-28B gene polymorphism instead of baseline LDL or HDL level differences. Occult hepatitis B (OBI) can be associated with a chronic hepatitis C virus (HCV) infection. Even in the absence of serological markers of hepatitis B, some patients in the study had OBI, which may have affected their treatment response. Cacciola et al.11 studied 200 patients with a chronic HCV infection. In their study, they found that an OBI virus infection was more common (33%) in HCV patients versus controls, and this association might have affected the treatment response with interferon therapy. We wonder if they have additional data about the serological status of the patients with respect to their OBI status. In conclusion, the study performed by Harrison et al.1 will certainly broaden our horizons with respect to the treatment of chronic HCV. However, we would like to share our concerns about the study, and we hope to have a scientific discussion with the authors. Tugrul Purnak M.D.*, Cumali Efe M.D. , Yavuz Beyazit M.D. , Ersan Ozaslan M.D.*, * Department of Gastroenterology, Ankara Numune Education and Research Hospital, Ankara, Turkey, Department of Internal Medicine, Bitlis Government Hospital, Bitlis, Turkey, Department of Gastroenterology, Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.