Clinical

Obesity tied to HCV treatment failure

Last Updated: 2006-06-15 9:55:02 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Obese patients with chronic hepatitis C virus (HCV) are more likely to have a better outcome if the underlying abnormalities caused by excessive adipose tissue are corrected, according to a review in the June issue of Hepatology.

The lead author, Dr. Michael R. Charlton of the Mayo Clinic, Rochester, Minnesota, and colleagues observe that the current understanding of obesity "is that it constitutes a metabolic condition and is not simply a function of having high body weight."

In HCV patients, they add, "obesity is associated with inflammation, insulin resistance, steatosis, progression of fibrosis, and nonresponse to treatment with interferon or peginterferon alpha and ribavirin."

Moreover, patients with both hepatitis C and obesity-related nonalcoholic fatty liver disease are at greater risk for more advanced liver disease.

Weight loss to reduce fat tissue is an important first step in improving response to treatment, say the investigators. Also important is use of drugs such as metformin and pioglitazone that improve insulin sensitivity and reduce fat accumulation in the liver. This might reverse disease progression.

Other approaches to enhance combination drug therapy may include longer duration of treatment and higher doses to counteract the decreased bioavailability. In addition, rather than basing doses on weight, use of peginterferon, for example, could be founded on a threshold body mass index.

"Treatment strategies that focus on improving underlying metabolic factors associated with poor response to combination therapy," conclude the researchers, are "more likely to overcome the low sustained viral response rates observed in obese patients infected with HCV."

Hepatology 2006;43:1177-1186.