Fatty Liver/Vitamin E , Genotype 3 and HCV

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Fatty Liver/Vitamin E , Genotype 3 and HCV

From Tina @ J & F Blog

Fatty Liver disease in HCV has been proven to be caused directly from the virus. Genotype 3 patients are known to have a higher rate of fatty liver then other genotypes. There was a time when genotype 2 and 3 were both thought of as being easily treated with standard HCV therapy.

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Ten Years ago when I entered the world of HCV; medical science used the same protocol for treatment with interferon based therapy in both genotypes.

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Finally studies proved that longer treatment duration may be needed in some genotype 3 patients.

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( years ago we used to debate this on the message boards, we all observed that geno 3 friends would not reach SVR as often as genotype 2 members did)

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See below for information and study links related to geno 3 treatment and fatty liver disease.

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Also the study on Vitamin E and fatty liver disease.

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.Steatosis is a condition characterised by the build up of fat within the liver, sometimes triggering inflammation of the liver. It is also known as fatty liver. It is only recently that the significance and relationship of steatosis to HCV has begun to be understood.

..There are two different forms of steatosis (Fatty Liver) that may be found in people with HCV: Metabolic steatosis and HCV-induced steatosis. .Metabolic steatosis can result from obesity, raised blood fat levels (hyperlipidemia), insulin resistance and type II diabetes and is similar to the type of fatty infiltration caused by excessive alcohol consumption and that is also found in Non-Alcoholic Fatty Liver (NASH).

Metabolic steatosis is not triggered by the hepatitis C virus; however the combination of this form of steatosis and the presence of HCV can lead to a more rapid progression of scarring or fibrosis.

..HCV-induced steatosis is fatty infiltration that is directly caused by the presence of the virus. It is possible for people with HCV to have both forms of steatosis simultaneously.

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Genotypes and Fatty Liver Disease:

/.Although it seems that all genotypes can trigger steatosis, the risk of developing steatosis is significantly higher for people with genotype 3. There is a complex reaction between the genotype 3 virus and liver cells that is not seen in other genotypes that makes this group at much higher risk of developing the condition. Around 40% of people with hepatitis C have steatosis, compared to about 14% to 31% of the general population. However, 60% - 80% of people with genotype 3 have moderate or severe steatosis.

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Hepatitis C virus genotypes 2 and 3 are both responsive to antiviral treatment, they have been regarded as similar. However, recent evidence has shown there may be differences between these two genotypes with regard to their clinical features and possibly responses to combined interferon and ribavirin therapy.

..As demonstrated in recent studies considering rapid virologic response (RVR) as a criterion for shortening treatment from the standard 24 weeks to 12 or 16 weeks in patients with genotype 2 or 3, the reason for lower response in genotype 3 versus genotype 2 patients may be a lower response rate in patients without an RVR. As a consequence, treatment longer than the currently recommended 24 weeks may be required for patients with genotype 3 but not for those with genotype 2 in the absence of an RVR. Whether this lower sensitivity to treatment in a subgroup of patients with genotype 3 may be attributed to viral heterogeneity or other associated cofactors is not yet known.

/Telaprevir Monotherapy Is Potent against HCV Genotype 2 but Not 3; Best Results when Combined with Interferon/ribavirin

../Genotype 3 patients, SVR rates were lower overall :

G3 telaprevir alone: SVR 50%;

G3 telaprevir/pegylated interferon/ribavirin: SVR 67%;

G3 pegylated interferon/ribavirin: SVR 44%.

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Therapy response to interferon-based regimen in patients with HCV genotype 3 infection is negatively affected by increasing age, suggesting that elderly patients (> 50 years old) with genotype 3 infection may need longer duration of therapy."

/Steatosis and HCV treatment

,There is increasing evidence that steatosis can reduce the effects of treatment. Some retrospective studies have shown that people with steatosis were less likely to achieve a sustained virologic response (SVR) even when taking into account other factors that might induce steatosis. One study found that sustained virologic response rates were 18-32% lower in people with steatosis compared to people without steatosis after adjusting for other co-factors that affect treatment such as genotype, fibrosis score, and viral load level. /

Diet and Excercise: A recent study found that HCV patients who participated in a diet and exercise program for three months lowered their grade of steatosis and, remarkably, their fibrosis score. ;./.

The Study

In this study we show that, besides alcohol consumption, an unbalanced diet is an important factor of hepatitis C evolution and nonresponse to antiviral treatment. Specific nutritional education and severe alcohol restrictions might, synergistically, improve the response to antiviral therapy..

Link :

The Impact of Diet on Liver Fibrosis and on Response to Interferon Therapy in Patients With HCV-Related Chronic Hepatitis

;. /Symptoms

.. /,Many people with steatosis experience no symptoms. Symptoms that people do experience are non-specific and liver enzymes levels are not necessarily raised. As with fibrosis, the definitive way to diagnose steatosis is a liver biopsy.

Vitamin E appears to be more effective in treating obesity-associated chronic liver disease than a prescription drug, U.S. researchers found.

Vitamin E, diabetes drug may reverse fatty liver disease

'' 'In a notable research, scientists claim to have found that vitamin E pills may help treat chronic liver disease.'

The research conducted by Virginia Commonwealth University (VCU), U.S., and funded by National Institutes of Health and Takeda Pharmaceutical revealed that vitamin E tablets could reverse nonalcoholic fatty liver disease--steatohepatitis.

Project scientist, Robuck, National Institute of Diabetes and Digestive and Kidney Diseases was quoted by Los Angeles

Times as saying, “This is an important landmark in the search for effective treatmentsfor (the disease).â€,

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THE STUDY

Explained By J & F Blog

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How Many People In The Study

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247

..How Long Was The Study ?.

A 96-week study including 247 adults in their mid-40s, suffering from steatohepatitis (Fatty Liver).

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None of them were diabetics or excessive drinkers, but all were obese.

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Assigned To Three Groups For Two Years

' .For the study, the subjects were randomly assigned three varied treatments for two years wherein they were given certain amount of medication on a daily basis.

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The First Group

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The first group was given 800 International Units (IU) of vitamin E

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The Second Group

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The second group was given 30 milligrams of the diabetes drug pioglitazone(an insulin-sensitizer) '.

Third Group

The third group was administered a *placebo treatment instead of medication. (*Placebo dummy medication)

All Had A Liver Biopsy After Treatment.

All the subjects underwent a liver biopsy at the commencement and finishing of the trial such that the researchers could arrive at comparative results. .

' The Big Reveal

,.First Group; Results of liver tissue characteristics during liver biopsies revealed that 43 percent of the vitamin E group had improved significantly.

,.Second Group; 34 percent of the group given the diabetes drug pioglitazone showed improvements

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Third Group; 19 percent improvement was shown of those given placebo treatment.' ,.Furthermore, the biopsy data revealed that vitamin E considerably reduced liver inflammation, fat accumulation and presence of dying ‘ballooning cells’ that appear in fatty liver tissue.

,The Second Group (diabetes drug pioglitazone) was found to improve insulin signaling, which helps diabetics metabolize sugar. However, it could also diminish the amount of fat in the liver, the researchers added./

“This confirms a long-term benefit for pioglitazone and gives an alternative option in the form of vitamin E,†Cusi, endocrinologist, University of Texas Health Science Center was quoted in ScienceNews as saying.

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'Robuck cautioned that vitamin E should only be taken under a doctor’s supervision. He was cited in Business Week as saying, “The trial included only a relatively healthy population with no diabetes and no cardiovascular disease.

For those people, it can be an important treatment.â€Arun Sanyal, MD, VCU stressed on further research and told ScienceNews, “It’s too early to recommend (vitamin E) as a panacea for fatty liver disease.â€

The study appears in New England Journal of Medicine.

Also see : HCV Herb glossary/Caution! Herbs and Nutritional Supplements

Vitamin Supplements: Are They for Everyone?

HCV New Drugs & Liver Health: Vitamin consumption

EASL/Vitamin D to conventional Peg/RBV therapy for naïve, genotype 1 patients with chronic infection significantly improve SVR.

DDW: Vitamin A Boosts Response to HCV Treatment

http://Hepatitis Cnewdrugs.blogspot.com/2010/05/fatty-livervitamin-e-and-hcv.html