Skip to main content

Advertisement

SpringerLink
Log in

Clinical and Pathological Risk Factors Associated with Liver Fibrosis and Steatosis in African-Americans with Chronic Hepatitis C

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aim

Several factors involved in the development of liver fibrosis in African-American patients with chronic hepatitis C have not been well studied. We aimed to evaluate some of these risk factors.

Methods

We reviewed pathology and medical records of 603 African-Americans with chronic hepatitis C virus (HCV) infection at Howard University Hospital from January 2004 to December 2013. Among the clinical and pathological data collected were HIV (human immunodeficiency virus), HCV genotype, hepatitis B virus (HBV), diabetes mellitus (DM), hypertension (HTN), body mass index (BMI), and hepatic steatosis.

Results

The frequency of DM, HTN, HIV, and HBV was 22, 16, 11, and 4%, respectively. Median BMI was 27.3 kg/m2. The frequency of fibrosis stages 0, 1, 2, 3, and 4 was 2, 48, 28, 11, and 11%, respectively. In multivariate logistic regression, we found a significant association between liver fibrosis stage (3–4 vs. 0–2) and HIV infection (OR 2.4, P = 0.026), HTN (OR 3.0, P = 0.001), age (OR 2.6 for every 10 years, P < 0.001), weight (OR 1.1 for every 10 lb increase, P = 0.002), and steatosis grade (OR 1.6, P = 0.002). The frequency of liver steatosis was 73%. In an ordinal logistic regression, significant risk factors for steatosis were female gender (OR 1.5, P = 0.034) and inflammation grade (P = 0.001).

Conclusion

This study shows that steatosis is independently associated with fibrosis in African-American patients with HCV infection. Female patients were at higher risk of steatosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rosato FE, Marks G. Changing site distribution patterns of colorectal cancer at Thomas Jefferson University Hospital. Dis Colon Rectum. 1981;24:93–95.

    Article  CAS  PubMed  Google Scholar 

  2. Lu M, Li J, Rupp LB, et al. Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma. J Viral Hepat. 2016;23:718–729.

    Article  PubMed  Google Scholar 

  3. Jensen DM, Morgan TR, Marcellin P, et al. Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon alpha-2a (40 kd)/ribavirin therapy. Hepatology. 2006;43:954–960.

    Article  CAS  PubMed  Google Scholar 

  4. Irshad M, Mankotia DS, Irshad K. An insight into the diagnosis and pathogenesis of hepatitis C virus infection. World J Gastroenterol. 2013;19:7896–7909.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lothe RA. Microsatellite instability in human solid tumors. Mol Med Today. 1997;3:61–68.

    Article  CAS  PubMed  Google Scholar 

  6. Petta S, Camma C, Di Marco V, et al. Insulin resistance and diabetes increase fibrosis in the liver of patients with genotype 1 HCV infection. Am J Gastroenterol. 2008;103:1136–1144.

    Article  CAS  PubMed  Google Scholar 

  7. Masuda K, Noguchi S, Ono M, et al. High fasting insulin concentrations may be a pivotal predictor for the severity of hepatic fibrosis beyond the glycemic status in nonalcoholic fatty liver disease patients before development of diabetes mellitus. Hepatol Res. 2016. doi:10.1111/hepr.12832.

    Google Scholar 

  8. Hui JM, Sud A, Farrell GC, et al. Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression. Gastroenterology. 2003;125:1695–1704.

    Article  CAS  PubMed  Google Scholar 

  9. Rubbia-Brandt L, Fabris P, Paganin S, et al. Steatosis affects chronic hepatitis C progression in a genotype-specific way. Gut. 2004;53:406–412.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Castera L, Hezode C, Roudot-Thoraval F, et al. Worsening of steatosis is an independent factor of fibrosis progression in untreated patients with chronic hepatitis C and paired liver biopsies. Gut. 2003;52:288–292.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Monto A, Alonzo J, Watson J, Grunfeld C, Wright T. Steatosis in chronic hepatitis C: relative contributions of obesity, diabetes mellitus, and alcohol. Hepatology. 2002;36:729–736.

    Article  PubMed  Google Scholar 

  12. Hourigan LF, Macdonald GA, Purdie D, et al. Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis. Hepatology. 1999;29:1215–1219.

    Article  CAS  PubMed  Google Scholar 

  13. Jacobson IM, Davis GL, El-Serag H, et al. Prevalence and challenges of liver diseases in patients with chronic hepatitis C virus infection. Clin Gastroenterol Hepatol. 2010;8:924–933. (quiz e117).

    Article  PubMed  Google Scholar 

  14. El-Serag HB, Kramer J, Duan Z, et al. Racial differences in the progression to cirrhosis and hepatocellular carcinoma in HCV-infected veterans. Am J Gastroenterol. 2014;109:1427–1435.

    Article  PubMed  Google Scholar 

  15. Irimia E, Mogoanta L, Predescu IO, et al. Liver steatosis associated with chronic hepatitis C. Rom J Morphol Embryol. 2014;55:351–356.

    PubMed  Google Scholar 

  16. Kahl S, Strassburger K, Nowotny B, et al. Comparison of liver fat indices for the diagnosis of hepatic steatosis and insulin resistance. PLoS ONE. 2014;9:e94059.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yoon EJ, Hu KQ. Hepatitis C virus (HCV) infection and hepatic steatosis. Int J Med Sci. 2006;3:53–56.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Matos CA, Perez RM, Pacheco MS, et al. Steatosis in chronic hepatitis C: relationship to the virus and host risk factors. J Gastroenterol Hepatol. 2006;21:1236–1239.

    Article  PubMed  Google Scholar 

  19. Iuliano AD, Feingold E, Wahed AS, et al. Host genetics, steatosis and insulin resistance among African Americans and Caucasian Americans with hepatitis C virus genotype-1 infection. Intervirology. 2009;52:49–56.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sterling RK, Contos MJ, Smith PG, et al. Steatohepatitis: risk factors and impact on disease severity in human immunodeficiency virus/hepatitis C virus coinfection. Hepatology. 2008;47:1118–1127.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Conjeevaram HS, Kleiner DE, Everhart JE, et al. Race, insulin resistance and hepatic steatosis in chronic hepatitis C. Hepatology. 2007;45:80–87.

    Article  CAS  PubMed  Google Scholar 

  22. Friedenberg F, Pungpapong S, Zaeri N, et al. The impact of diabetes and obesity on liver histology in patients with hepatitis C. Diabetes Obes Metab. 2003;5:150–155.

    Article  CAS  PubMed  Google Scholar 

  23. Marabita F, Aghemo A, De Nicola S, et al. Genetic variation in the interleukin-28B gene is not associated with fibrosis progression in patients with chronic hepatitis C and known date of infection. Hepatology. 2011;54:1127–1134.

    Article  CAS  PubMed  Google Scholar 

  24. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997;349:825–832.

    Article  CAS  PubMed  Google Scholar 

  25. Clouston AD, Jonsson JR, Purdie DM, et al. Steatosis and chronic hepatitis C: analysis of fibrosis and stellate cell activation. J Hepatol. 2001;34:314–320.

    Article  CAS  PubMed  Google Scholar 

  26. Shima T, Seki K, Umemura A, et al. Influence of lifestyle-related diseases and age on the development and progression of nonalcoholic fatty liver disease. Hepatol Res. 2015;45:548–559.

    Article  PubMed  Google Scholar 

  27. Terrault NA, Im K, Boylan R, et al. Fibrosis progression in African Americans and Caucasian Americans with chronic hepatitis C. Clin Gastroenterol Hepatol. 2008;6:1403–1411.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Clausen LN. Factors associated with resolution and progression of HIV/hepatitis C virus infection. Dan Med J. 2014;61:B4838.

    PubMed  Google Scholar 

  29. Chen JY, Feeney ER, Chung RT. HCV and HIV co-infection: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2014;11:362–371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Lin W, Wu G, Li S, et al. HIV and HCV cooperatively promote hepatic fibrogenesis via induction of reactive oxygen species and NFkappaB. J Biol Chem. 2011;286:2665–2674.

    Article  CAS  PubMed  Google Scholar 

  31. Loria P, Adinolfi LE, Bellentani S, et al. Practice guidelines for the diagnosis and management of nonalcoholic fatty liver disease: a decalogue from the Italian Association for the Study of the Liver (AISF) Expert Committee. Dig Liver Dis. 2010;42:272–282.

    Article  CAS  PubMed  Google Scholar 

  32. Persico M, Iolascon A. Steatosis as a co-factor in chronic liver diseases. World J Gastroenterol. 2010;16:1171–1176.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Poynard T, Ratziu V, McHutchison J, et al. Effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology. 2003;38:75–85.

    Article  CAS  PubMed  Google Scholar 

  34. Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–1395.

    Article  PubMed  Google Scholar 

  35. Nelson JE, Wilson L, Brunt EM, et al. Relationship between the pattern of hepatic iron deposition and histological severity in nonalcoholic fatty liver disease. Hepatology. 2011;53:448–457.

    Article  CAS  PubMed  Google Scholar 

  36. Valenti L, Fracanzani AL, Bugianesi E, et al. HFE genotype, parenchymal iron accumulation, and liver fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2010;138:905–912.

    Article  CAS  PubMed  Google Scholar 

  37. Sumida Y, Nakashima T, Yoh T, et al. Serum thioredoxin levels as a predictor of steatohepatitis in patients with nonalcoholic fatty liver disease. J Hepatol. 2003;38:32–38.

    Article  CAS  PubMed  Google Scholar 

  38. George DK, Goldwurm S, MacDonald GA, et al. Increased hepatic iron concentration in nonalcoholic steatohepatitis is associated with increased fibrosis. Gastroenterology. 1998;114:311–318.

    Article  CAS  PubMed  Google Scholar 

  39. Czaja AJ. Hepatic inflammation and progressive liver fibrosis in chronic liver disease. World J Gastroenterol. 2014;20:2515–2532.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Koizumi Y, Hirooka M, Kisaka Y, et al. Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography–establishment of the method for measurement. Radiology. 2011;258:610–617.

    Article  PubMed  Google Scholar 

  41. McCaughan GW, George J. Fibrosis progression in chronic hepatitis C virus infection. Gut. 2004;53:318–321.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Baden R, Rockstroh JK, Buti M. Natural history and management of hepatitis C: does sex play a role? J Infect Dis. 2014;209:S81–S85.

    Article  CAS  PubMed  Google Scholar 

  43. Africa JA, Behling CA, Brunt EM, et al. Nonalcoholic steatohepatitis clinical research network (NASH CRN): in children with nonalcoholic fatty liver disease, zone 1 steatosis is associated with advanced fibrosis. Clin Gastroenterol Hepatol. 2017. doi:10.1016/j.cgh.2017.02.030.

    PubMed  Google Scholar 

  44. AlQaraawi AM, Sanai FM, Al-Husseini H, et al. Prevalence and impact of hepatic steatosis on the response to antiviral therapy in Saudi patients with genotypes 1 and 4 chronic hepatitis C. Dig Dis Sci. 2011;56:1222–1228.

    Article  CAS  PubMed  Google Scholar 

  45. Adinolfi LE, Gambardella M, Andreana A, et al. Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity. Hepatology. 2001;33:1358–1364.

    Article  CAS  PubMed  Google Scholar 

  46. Dufour JF, DeLellis R, Kaplan MM. Regression of hepatic fibrosis in hepatitis C with long-term interferon treatment. Dig Dis Sci. 1998;43:2573–2576. (Medline).

    Article  CAS  PubMed  Google Scholar 

  47. Niederau C, Fischer R, Sonnenberg A, Stremmel W, Trampisch HJ, Strohmeyer G. Survival and causes of death in cirrhotic and in noncirrhotic patients with primary hemochromatosis. N Engl J Med. 1985;313:1256–1262.

    Article  CAS  PubMed  Google Scholar 

  48. Dufour JF, DeLellis R, Kaplan MM. Reversibility of hepatic fibrosis in autoimmune hepatitis. Ann Intern Med. 1997;127:981–985.

    Article  CAS  PubMed  Google Scholar 

  49. Campana L, Iredale JP. Regression of liver fibrosis. Semin Liver Dis. 2017;37:1–10.

    Article  PubMed  Google Scholar 

  50. Jung YK, Yim HJ. Reversal of liver cirrhosis: current evidence and expectations. Korean J Intern Med. 2017;32:213–228.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Knop V, Hoppe D, Welzel T, et al. Regression of fibrosis and portal hypertension in HCV-associated cirrhosis and sustained virologic response after interferon-free antiviral therapy. J Viral Hepat. 2016;23:994–1002.

    Article  CAS  PubMed  Google Scholar 

  52. Sun M, Kisseleva T. Reversibility of liver fibrosis. Clin Res Hepatol Gastroenterol. 2015;39:S60–S63.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Lee YA, Wallace MC, Friedman SL. Pathobiology of liver fibrosis: a translational success story. Gut. 2015;64:830–841.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This project was supported (in part) by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Numbers G12MD007597 and U01CA185188. We would like to thank Dr. El-Serag for his critical review of this manuscript.

Author information

Authors and Affiliations

  1. Department of Medicine and Cancer Research Center, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA

    Ali Afsari, Tina Boortalary, Zaki A. Sherif, Adeyinka O. Laiyemo, Kawtar Alkhalloufi, Hassan Brim & Hassan Ashktorab

  2. Department of Pathology, Howard University College of Medicine, Washington, DC, USA

    Ali Afsari, Edward Lee, Babak Shokrani & Hassan Brim

  3. Department of Biochemistry and Molecular Biology, Howard University College of Medicine, Washington, DC, USA

    Zaki A. Sherif

  4. Department of Medicine and Vascular Institute Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Mehdi Nouraie

Authors
  1. Ali Afsari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Babak Shokrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tina Boortalary
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zaki A. Sherif
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehdi Nouraie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adeyinka O. Laiyemo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kawtar Alkhalloufi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hassan Brim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hassan Ashktorab
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hassan Ashktorab.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Afsari, A., Lee, E., Shokrani, B. et al. Clinical and Pathological Risk Factors Associated with Liver Fibrosis and Steatosis in African-Americans with Chronic Hepatitis C. Dig Dis Sci 62, 2159–2165 (2017). https://doi.org/10.1007/s10620-017-4626-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4626-7

Keywords

Search

Navigation