Association between Antioxidant Use and the Prevalence and Severity of Steatosis and Fibrosis in Patients with Chronic Hepatitis C Virus Infection

Abstract

Purpose: Oxidative stress is increased in patients with chronic hepatitis C virus (HCV) infection and may be involved in the pathogenesis of this disease. Therefore, antioxidant therapy may be beneficial for the treatment of HCV-associated liver disease. The aims of the present study were to compare the prevalence and severity of steatosis and fibrosis among patients who were and those who were not taking antioxidants. Methods: Consecutive patients undergoing liver biopsy were prospectively identified and were interviewed by a research assistant who obtained detailed demographic and clinical data, as well as information on the use of antioxidants (vitamin C and E). Steatosis was scored according to the percent of hepatocytes involved as none (no steatosis), mild (<33%), moderate (33%–66%), or severe (>66%) using the Brunt system; fibrosis was scored on a scale from 0–4. Results: Of the 577 patients enrolled, current antioxidant use was reported by 241 subjects (41.8%). Overall, 336 (58.2%) were not taking any antioxidants, 99 (17.2%) used vitamin C only, 62 (10.7%) used vitamin E only, and 80 (13.9%) were taking both vitamin C and E. The prevalence of steatosis of any grade (42.3% vs 60.1%, p < 0.001), moderate-severe steatosis (15.8% vs 24.7%, p = 0.009), and stage 3/4 fibrosis (23.7% vs 34.5%, p = 0.005) were significantly lower in patients who were taking antioxidants as compared to those who were not taking these supplements. The lower odds of steatosis (OR = 0.46; 95% CI, 0.31–0.69) and stage 3/4 fibrosis (OR = 0.68; 95% CI, 0.42–0.94) among patients who were taking antioxidants remained significant even after adjusting for age, gender, race, alcohol use, diabetes, BMI, triglycerides, and HCV genotype. However, the prevalence of steatosis (45.0% vs 42.4% vs 38.7%, p = 0.75) and stage 3/4 fibrosis (31.3% vs 19.2%, vs 21.0%, p = 0.14) among patients who were taking both vitamin C and E was not significantly different from those who were taking vitamin C alone or vitamin E alone. Conclusions: Antioxidant use was associated with a significantly lower prevalence and severity of steatosis and fibrosis among patients with chronic HCV infection. However, we found no evidence of a synergistic effect among patients taking both vitamin C and E as compared to those who were only taking one of these supplements. Randomized controlled trials to evaluate the beneficial effect of antioxidants are warranted in patients with chronic HCV infection.