Chronic hepatitis C and steatosis

Steatosis is a common finding in chronic hepatitis C infection. It is associated with increased fibrogenesis and, in nongenotype 3 infection, with a reduced response to antiviral therapy. The steatosis is multifactorial; host factors, particularly excess body mass and insulin resistance, and viral cytopathic effects each play a variable role in different genotypes. How steatosis or the accompanying metabolic changes potentiate fibrosis remains enigmatic, but evidence is emerging that implicates oxidative stress, hyperinsulinemia, enhanced hepatocyte death, or altered regeneration programs. Tumorigenesis may also be increased. By reducing steatosis, and in some instances fibrosis, weight loss or other therapies targeting insulin resistance may have a role in those patients who have failed antiviral treatment.