Elevated Body Mass Index (BMI) in Patients With Hepatitis C Virus (HCV) Infection as a Predictor of Non-Alcoholic Fatty Liver Disease (NAFLD) / Non-Alcoholic Steatohepatitis (NASH) Post-Sustained Virologic Response (SVR)

Abstract

Introduction: HCV infection is associated with hepatic steatosis. In HCV genotype 3 (G3) steatosis is of viral origin. In HCV non-genotype 3 the steatosis is mainly linked to host factors.1 Patients with HCV and NAFLD are likely to be heavier and have diabetes mellitus (DM), hypertension (HTN) and hypertriglyceridemia than those with HCV alone.2 This study will use alanine aminotransferase (ALT), BMI, blood pressure (BP), imaging, fibrosis score, kilopascal (kPa) and Controlled Attenuation Parameter (CAP) score of >238 to indicate significant steatosis and suggest NAFLD/NASH3. Aim: To determine if elevated LFTs in patients with HCV post-SVR is an indicator of NAFLD or NASH as evidenced by a CAP >238. Methods: A retrospective chart review of outpatients was conducted to identify patients wtih HCV post-SVR with CAP scores >238. The following were collected; Height, Weight, BMI, SVR, HCV Genotype, Gender, Age, aspartate aminotransferase (AST), ALT, kPa, CAP, ultrasound, Magnetic Resonance Imaging (MRI), BP. Descriptive analysis was performed to determine frequencies and averages. We performed univariate analysis and astepwise, forward, multivariate, regression analysis of specified baseline characteristics and clinical parameters to identify factors associated with persistent elevated liver enzymes. All statistical analysis was performed using JMP 13 software by SAS. Results: A total of 24 patients met eligibility criteria, two thirds were male, mean age 64 (33-76) years, mean ALT 34.25, mean BMI 26.76, mean CAP 286.41, The predominant, HCV Genotype 1 =20, followed by Genotype 3=3, mean kPa 7.7 (3.2-26.3). History of alcohol abuse was assessed and no subject had alcohol abuse. Univariate analysis show no significant association between AST, ALT or gender and CAP score. There is a significant correlation between BMI and CAP in a univariate model (p=0.0123). Also of note, in this particular sample Females have a trend towards higher CAP scores than men (ChiSquare 2.0498). In a multivariate model ALT and AST are not predictors of elevated CAP scores in HCV patients with SVR In a multivariate model BMI is significantly associated with elevated CAP scores in HCV patients with SVR (p=0.0129) Conclusion: In HCV patients post-SVR an elevated BMI may be an indicator of NAFLD/NASH. These patients should be further evaluated and followed regardless of fibrosis score for the progression of liver disease due to NAFLD/NASH. Larger studies to assess these relationships are needed.