LIVER STEATOSIS AND CHRONIC HEPATITIS-C - A SPURIOUS ASSOCIATION

Objective: Based on the observation of steatosis in the majority of li ver biopsy specimens from hepatitis C virus (HCV) infected patients, i t has been suggested that HCV may be pathogenetically implicated. We a imed to determine the influence of possible underlying metabolic disor ders on this association. Design: In a series of 148 consecutive patie nts with chronic hepatitis, with and without HCV infection, we evaluat ed by logistic regression analysis the association between steatosis a nd HCV, controlling for diabetes, obesity, hyperlipidaemia and alcohol . These are all known to be factors associated with a fatty liver, and also with the histological degree of liver disease. Results: Antibodi es to HCV were detected in 121 of 148 (81.8%) patients. Steatosis, dis tributed in different histological patterns, was found in 73 of 121 (6 0%) HCV-positive and in 14 of 27 (52%) HCV-negative patients (P = NS). Using simple logistic regression, the association of HCV to steatosis was weak and not statistically significant (OR, 1.41; 95% CI, 0.61-3. 27). The same was true for hyperlipidaemia (OR, 4.45; 95% CI, 0.52-37. 9). A strong and statistically significant association was found, howe ver, between obesity and steatosis (OR, 4.18) and between steatosis an d the highest degree of histological severity (Liver cirrhosis vs chro nic persistent hepatitis: OR, 12.8). Using multivariate analysis, the association between steatosis and HCV was shown to be not significant. Hyperlipidaemia, among all the independent variables tested, was show n to be co-linear with obesity. Conclusion: Our findings seem to sugge st that HCV is irrelevant as a risk factor for a fatty liver. The resu lts indicated that there is a 'confounding' role of obesity and hyperl ipidaemia, and that the severity of liver disease is associated with s teatosis and HCV.