Hepatitis C recurrence: Influence of serum cholesterol levels and liver steatosis on antiviral therapy
Authors: Gianni Testino, Paolo Borro
Journal: Hepatology (2010)

We read the excellent article by Harrison et al.,1 who showed that elevated baseline low-density lipoprotein levels are associated with higher sustained virological response (SVR) rates. In our experience with 32 transplant patients who suffered hepatitis C recurrence and were treated with peginterferon alfa-2b and ribavirin, the total cholesterol (TC) levels (mg/dL) did not influence SVR.2 In this particular group of patients, the importance of parameters such as the body mass index (BMI; kg/m2), triglyceride (TGC) levels (ng/mL), and hepatic percentage of steatosis in the response to antiviral therapy was demonstrated. Ten patients (31.2%) stopped their therapy because of side effects. The observed BMI values, TC levels, TGC levels, and percentages of steatosis were confirmed to be normally distributed by the one-sample Kolmogorov-Smirnov goodness-of-fit test procedure. Comparisons of the BMI values, TC levels, TGC levels, and percentages of steatosis between nonresponse (NR), SVR, and sustained biochemical response (SBR) groups were analyzed by analysis of variance with the post hoc Bonferroni test, and correlations between variables were tested with the Pearson test. A univariate analysis was performed to estimate the chance of a response according to the aforementioned variables. The BMI values (26.8 ± 3.3 kg/m2), TGC levels (245.3 ± 84.4 ng/mL), and percentages of steatosis (26.8% ± 23.6%) in the NR group (nine cases) were higher than those observed in the SVR group [six cases; 20.4 ± 2.6 kg/m2 (P < 0.001), 108.3 ± 48.4 ng/mL (P = 0.002), and 5.75% ± 2.2% (P = 0.027), respectively] and in the SBR group [seven cases; 21.5 ± 1.6 kg/m2 (P = 0.003), 132.4 ± 51.2 ng/mL (P = 0.008), and 6.2% ± 2.4% (P = 0.033), respectively]. The differences between the SVR and SBR groups were not significant for the aforementioned variables. As for cholesterol, no significant differences were registered between the NR group (197.6 ± 47.3 mg/dL), the SVR group (149.3 ± 37 mg/dL), and the SBR group (153.4 ± 41.5 mg/dL). The Pearson correlation test (correlation coefficient >0.7, P < 0.001 for every correlation) showed a strong correlation between the BMI values, cholesterol levels, TGC levels, and percentages of steatosis. For patients with a BMI <25 kg/m2 and TGC levels < 160 ng/mL, the chance of SVR was 48 times higher than the chance of NR. The chances of SVR and SBR for patients with <15% steatosis were 12 times the chances for patients with higher percentages of steatosis. After liver transplantation (LT), serum cholesterol levels are probably not determinant because metabolic syndrome and liver steatosis are frequently present after LT.3 In fact, the observed diminished response has been hypothesized to be due to decreased interferon bioavailability in overweight patients and the presence of hepatic steatosis, which itself is a predictor of a poor response to antiviral treatment.4-6 After LT, metabolic syndrome and liver steatosis could lead to altered viral clearance and a decrease in SVR independently of cholesterol levels. Gianni Testino M.D.*, Paolo Borro M.D.*, * Department of Specialistic Medicine, San Martino Hospital, Genoa, Italy.