Obesity and Response to Hepatitis C Therapy. Hossam Kandil Gastroenterology& Nutrition University of Pittsburgh May 2010. Natural History of Hepatitis C. Acute Hepatitis C. 10-20 years. Chronic Hepatitis 75%-85 %. Cirrhosis 20 %. Annual rate. Decompensation 3-6 %.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
University of Pittsburgh
Acute Hepatitis C
Cirrhosis 20 %
Decompensation 3-6 %
Multiple Logistic Regression Analysis
Odds Ratio (95% CI)
No effect on SVR
Greater effect on SVR
Randomizes control Study of Peg-INFa2a versus IFNa2a 3X/week
(BMI (> vs ≤ 28) and weight > vs ≤85 kg were NOT risk factors)
Zeuzem S. NEJM 2000;343:1666-72.
Prospective study of 145 patients with CHC
Factors Associated with Non-Response
OR (95% CI)
Genotypes 1 & 4 4.1 (1.9 – 8.9)*
Cirrhosis 3.2 (1.2 – 9.0)*
Obesity 3.9 (1.4 – 11.2)*
Walsh MJ. Gut 2006;55:529-35
Fatty liver Disease
Insulin Resistant State
Regulate Hepatic Inflammatory Response
Abnormal production of hormones & cytokines that regulate inflammatory responses
Higher annular rate of fibrosis progression
suppressors of IFNa activity (e.g. SOCS).
TH-1 to TH-2
If obese subjects do not respond to standard hepatitis C treatment;
Can weight management improve response to Hepatitis C treatment??
Hany Alwakeel MD, Hassan Zaghla MD PhD, Nabeel Omar MD PhD, Hassan Alshinnawy MD PhD, Eman Rewisha MD PhD, Azza Taha MD, Stephen O’Keefe MD MSc, Toby Graham MD, Hossam Kandil MD, PhD
National Liver Institute, Shibin Alkom, Menofeya, Egypt
University of Pittsburgh Medical Center, Pittsburgh, PA
JPEN 2010, H44-6
- Weight loss = BMI decreased by 0.5 kg/m2 or more versus pre-treatment BMI
Viral response rates compared among WL and NWL
Viral clearance at 4 weeks
2 log drop in viral load at 12 weeks
Viral clearance at 48 weeks
Viral clearance at 72 wks
RVR and EVR significantly associated with SVR
Age Wt loss @ 1 m* Genotype*
Race Wt loss @ 3 m *Age*
Viral load Age Longer Treat*
Genotype* Longer Treat *Viral load*
* Independently associated with +ve response by multivariate regression analysis
Randomized, Double Blind, Placebo Controlled Pprospective Study.
Standard 12 month treatment
Pegylated Interferon + Ribavirin
Monthly follou up cessions