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THE IMPACT OF BODY MASS INDEX (BMI) ON LIVER HISTOLOGY AND TREATMENT TOLERABILITY AND EFFICACY IN CHRONIC HEPATITIS C
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DDW (Digestive Disease Week) Conference, May 17-22, 2003, Orlando, Fl. Abstract 238. Glenn K Harvin, Lucia G Miles, Nancy L Huntley, Ira R Willner, Adrian Reuben, Charleston, SC.
There is increasing evidence that obesity, a major risk factor for fatty liver disease, may aggravate other liver disorders such as chronic hepatitis C (CHC). Fatty liver is when fat accumulates in liver cells in the liver. This syndrome can be associated with alcohol use but can occur without excessive alcohol use. However, it is unclear to what extent obesity and obesity-related steatosis (fatty liver) adversely affect liver inflammation and fibrosis in CHC or the tolerability and efficacy of pegylated interferon (PEG)/ribavirin (RBV) therapy.
This study examined the impact of body mass index (BMI), the size of your body, on 1) liver histology (stage of liver disease), 2) tolerability of PEG/RBV therapy, and 3) viral clearance after 6 months' treatment with a weight-based dose regimen in patients selected for therapy according to standard criteria.
The study is a retrospective review of 1) liver histology, 2) treatment records documenting symptoms, serial blood counts, dose adjustments and hematologic growth factor use, and 3) 6-months' circulating hepatitis C viral RNA levels, assayed by quantitative and/or qualitative PCR, in Liver Clinic patients with biopsy-proven viremic CHC.
85 patients were studied, 49 men and 36 women, of mean age 43 yrs (range 27-57) and mean BMI (weight/height) 29.1 +/- 7.3, of whom 79 were white, 5 African-American and 1 Hispanic. Hepatitis C genotypes (n=81) were 1a/b: 65, 2a/b: 10, 3: 5, and 4: 1.
Advanced hepatic fibrosis (stages 3-4) was significantly more prevalent (26/60 patients) in overweight and obese patients (BMI ≥25) than in normal weight (5/25 patients, BMI <25, p<0.02), whereas there was no difference in grade of inflammatory activity between the 2 groups.
Of the 44 patients treated with PEG-RBV, only 5/14 of BMI <25 required dose reductions with or without growth factors for anemia and/or leukopenia, compared to 21/30 of BMI ≥25 (p<0.05).
Interim (6 month) viral clearance rates were similar in both groups, at 11/14 for BMI <25 and 26/30 for BMI ≥25 patients, respectively.
The authors concluded that in patients with chronic hepatitis C, increased BMI is associated with advanced fibrosis and poor toleration of PEG-RBV but not with impaired (interim) viral clearance. Another study reported at DDW that fatty liver can reduce response to therapy. The authors suggest that BMI should be taken into account in future PEG/RBV dose regimens.
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