IMPACT OF HEPATIC STEATOSIS ON DISEASE COURSE IN PATIENTS WITH COMPENSATED HEPATITIS C VIRUS-RELATED CIRRHOSIS RECEIVING INTERFERON-FREE THERAPY (PARITAPREVIR, RITONAVIR, OMBITASVIR DASABUVIR AND RIBAVIRINA)
Aim: In Romania, genotype 1 of hepatitis C virus (HCV) is the most common and the aim of this study was to assess comparatively the biochemical, hematological and virological parameters in patients with different degrees of steatosis before the initiation of interferon-free therapy (paritaprevir/ritonavir/ombitasvir/ dasabuvir plus ribavirin) (PrOD-R) and at its completion. Material and methods: This retrospective study included 113 patients with compensated liver cirrhosis with C-genotype 1b, treated with PrOD-R evaluated and clinically-biologically monitored at the Iasi Hospital of Infectious Diseases between November 2015 and May 2017. Results: We found an advanced steatosis (grades ≥2) in 54% of patients. Associated cardiovascular and kidney diseases and diabetes mellitus were more frequent in the group of patients with advanced steatosis compared to the group with incipient steatosis (19.5% vs. 8% and 10.6% vs. 0.9%, respectively) (p = 0.02 and p = 0.003, respectively). In most patients the hepatic cytolysis syndrome was identified before the initiation of therapy (93%) with a significant difference between patients with advanced versus low grade steatosis (53% vs. 40%, respectively, p = 0.014). In patients with steatosis grade ≥2, GGT levels above the normal range were detected in 52.2% cases and in the group with steatosis grade <2 in 31% (p = 0.0003). At the time of treatment initiation, only 3.5% of patients presented various grades of anemia, but at the end of therapy 38% had different grades of anemia, this anomaly being more common in patients with advanced steatosis (23% vs. 15%, respectively, p = 0.27). At the end of therapy, only 14.2% still had higher-than-normal ALT levels, most of them in the group with advanced steatosis (11.5% vs. 2.6%, respectively, p = 0.018). Conclusions: We found a significant correlation between the advanced grade of hepatic steatosis and the levels of hepatic cytolysis enzymes and GGT both before initiation of therapy and at its completion in patients with advanced steatosis.
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