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Name of journal: World Journal of GastroenterologyManuscript NO: 37399Manuscript type: ORIGINAL ARTICLEProspective StudyFatty liver in hepatitis C patients post-sustained virological response with direct-acting antiviralsNoureddin M et al. Fatty liver post-SVR with DAAs in HCVMazen Noureddin, Micaela M Wong, Tsuyoshi Todo, Shelly C Lu, Arun J Sanyal, Edward A MenaMazen Noureddin, Fatty Liver Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United StatesMazen Noureddin, Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United StatesMicaela M Wong, California Liver Research Institute, Pasadena, CA 91105, United StatesTsuyoshi Todo, Comprehensive Transplant Center, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United StatesShelly C Lu, Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United StatesArun J Sanyal, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, United StatesEdward A Mena, California Liver Research Institute, Pasadena, CA 91105, United StatesORCID number: Mazen Noureddin (0000-0003-2127-2040); Micaela M Wong (0000-0001-9912-2574); Tsuyoshi Todo (0000-0003-1264-9301); Shelly C Lu (0000-0003-2128-5407); Arun J Sanyal ( 0000-0001-8682-5748); Edward A Mena (0000-0003-0631-9525).Author contributions: Noureddin M provided the study concept and design; Noureddin M, Wong MM and Mena EA contributed to acquisition of data; Noureddin M, Wong MM, Todo T, Lu SC and Sanyal AJ contributed to analysis and interpretation of data; Noureddin M drafted the manuscript; Noureddin M, Wong MM, Todo T, Lu SC, Sanyal AJ and Mena EA contributed to critical revision of the manuscript for important intellectual content; Noureddin M contributed to the statistical analysis; Noureddin M and Mena EA provided administrative and technical support and study supervision; Wong MM provided support for carrying out the study; all authors gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.Institutional review board statement: This study was approved by the Central Institutional Review rmed consent statement: Informed voluntary consent was acquired from all the study participants.Conflict-of-interest statement: Noureddin M has been on the advisory board or a speaker for EchoSens North America, OWL, Intercept and Abbott; Noureddin M has received research support from Gilead, Galmed, Galectin, Conatus, Zydus and Shire; Noureddin M is a minor shareholder of Anaetos; Sanyal AJ has been a consultant to Intercept, Galectin, BMS, Nitto Denko, Nimbus, Aredlyx, Vivelyx, and Tandeva; Sanyal AJ has received grants from Gilead, Intercept, Novartis, Merck, BMS, and Tobira; Sanyal AJ has stock or stock options in Genfit, Akarna, Tiziana, Natural Shield, Durect, and Exhalenz. Mena EA has received research support from Galmed, Conatus, Shire, Merck and Gilead; Mena EA has been a consultant and advisor to Gilead, Abbvie, Merck, Bayer, and Grifalos; Mena EA is a member of the speakers’ bureaus for Gilead, Abbvie, Merck, Bayer, Echosens North America and Grifalos; Mena EA owns stocks in Gilead and Galectin; The other authors report no conflicts of interest.Data sharing statement: The statistical code and dataset are available from the corresponding author at mazen.noureddin@. Consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low. Open-Access: This article is an open-access?article?which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed?in?accordance?with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: source: Unsolicited manuscriptCorrespondence to: Mazen Noureddin, MD, MHSc, Associate Professor, Division of Digestive and Liver Diseases, Comprehensive Transplant Program, Cedars-Sinai Medical Center, 8900 Beverly Blvd, Suite 250, Los Angeles, CA 90048 United States. mazen.noureddin@Telephone: +1-310-4237088Fax: +1-310-2488197Received: December 3, 2017Peer-review started: December 5, 2017First decision: December 14, 2017Revised: January 27, 2018Accepted: March 3, 2018 Article in press:Published online: AbstractAIMTo determine steatosis and fibrosis prevalence in hepatitis C patients after a sustained virological response achieved with direct-acting antivirals. METHODSTransient elastography with controlled attenuation parameter (CAP) was used to assess hepatic steatosis post-sustained virological response (SVR); the CAP technology was not available in the United States at study initiation. Liver stiffness/fibrosis was measured before and 47 wk after treatment completion. Patients with genotype 3 and patients with cirrhosis were excluded.RESULTS101 patients were included in the study. Post-SVR there were decreases from baseline in alanine aminotransferase (ALT) (63.1 to 17.8 U/L), aspartate aminotransferase (51.8 to 21.5 U/L) and fibrosis score (7.4 to 6.1 kPa) (P < 0.05). Post-SVR, 48 patients (47.5%) had steatosis on CAP; of these, 6.25% had advanced fibrosis. Patients with steatosis had higher body mass index (29.0 vs 26.1 kg/m2), glucose (107.8 vs 96.6 mg/dL), ALT (20.4 vs 15.3 mg/dL), CAP score (296.3 vs 212.4 dB/m) and fibrosis score (7.0 vs 5.3 kPa); P < 0.05. Interestingly, compared to baseline, both patients with and without steatosis had change in fibrosis score post-SVR (7.7 vs 7.0 kPa and 7.0 vs 5.3 kPa); alternatively, (P < 0.05) and therefore patients with steatosis continued to have clinically significant stiffness (≥ 7 kPa).CONCLUSIONFatty liver is very common in hepatitis C virus (HCV) patients post-SVR. These patients continue to have elevated mean fibrosis score (≥ 7 kPa) compared to those without fatty liver; some have advanced fibrosis. Long term follow up is needed to assess steatosis and fibrosis in HCV patients post-SVR. Key words: Nonalcoholic fatty liver disease; Hepatitis C; Fibrosis; Steatosis; Sustained virological response; Direct-acting antivirals? The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.Core tip: This is the first prospective study to assess the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals. The study’s findings that fatty liver is present in 47.5% of these patients and that some steatotic patients have clinically significant fibrosis despite normal liver enzymes should raise awareness of the post-sustained virological response (SVR) prevalence of fatty liver and the importance of post-SVR assessment of steatosis and fibrosis and long-term follow up with these patients. Noureddin M, Wong MM, Todo T, Lu SC, Sanyal AJ, Mena EA. Fatty liver in hepatitis C patients post-sustained virological response with direct-acting antivirals. World J Gastroenterol 2018; In pressIntroductionWith the growing epidemic of obesity and type 2 diabetes mellitus, nonalcoholic fatty liver disease (NAFLD) currently has a worldwide prevalence of 25.24% (approximately 1.8 billion people) ADDIN EN.CITE <EndNote><Cite><Author>Younossi</Author><Year>2016</Year><RecNum>22</RecNum><DisplayText><style face="superscript">[1]</style></DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1497092279">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Younossi, Z. M.</author><author>Koenig, A. B.</author><author>Abdelatif, D.</author><author>Fazel, Y.</author><author>Henry, L.</author><author>Wymer, M.</author></authors></contributors><auth-address>Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA.
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
Center for Outcomes Research in Liver Disease, Washington, DC.</auth-address><titles><title>Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>73-84</pages><volume>64</volume><number>1</number><dates><year>2016</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>26707365</accession-num><urls><related-urls><url>;[1], making it the most common cause of chronic liver disease (CLD), followed by chronic hepatitis B (CHB, 257 million people), and chronic hepatitis C (CHC, 71 million people) ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2017</Year><RecNum>51</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1497951241">51</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>World Health Organization,,</author></authors><tertiary-authors><author>World Health Organization</author></tertiary-authors></contributors><titles><title>Global hepatitis report 2017</title></titles><pages>83</pages><dates><year>2017</year><pub-dates><date>April</date></pub-dates></dates><pub-location>Geneva, Switzerland</pub-location><publisher>World Health Organization</publisher><urls><related-urls><url>;[2]. In the United States, NAFLD and CHC are the two most common CLD causes ADDIN EN.CITE <EndNote><Cite><Author>Setiawan</Author><Year>2016</Year><RecNum>13</RecNum><DisplayText><style face="superscript">[3]</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493517800">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Setiawan, V. W.</author><author>Stram, D. O.</author><author>Porcel, J.</author><author>Lu, S. C.</author><author>Le Marchand, L.</author><author>Noureddin, M.</author></authors></contributors><auth-address>Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA.
Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles, CA.
Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI.
Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.</auth-address><titles><title>Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1969-1977</pages><volume>64</volume><number>6</number><dates><year>2016</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>27301913</accession-num><urls><related-urls><url>;[3], and nonalcoholic steatohepatitis (NASH)-associated cirrhosis is the second leading indication for liver transplant (LT) after hepatitis C virus (HCV)-associated end-stage liver diseasePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Xb25nPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [4]. With the recent study that showed that between 2004 and 2013 the number of adult patients with NASH awaiting LTs almost tripledPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Xb25nPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [4], combined with the rapidly expanding population of CHC patients achieving sustained virological responses (SVRs) with direct-acting antivirals (DAAs), it is thought that NASH may soon become the leading indication for LT. NAFLD prevalence is now estimated to be approximately 30% in the United States ADDIN EN.CITE <EndNote><Cite><Author>Vernon</Author><Year>2011</Year><RecNum>20</RecNum><DisplayText><style face="superscript">[5]</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493606333">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vernon, G.</author><author>Baranova, A.</author><author>Younossi, Z. M.</author></authors></contributors><auth-address>Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA 22042, USA.</auth-address><titles><title>Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>274-85</pages><volume>34</volume><number>3</number><keywords><keyword>Adult</keyword><keyword>Biopsy</keyword><keyword>Fatty Liver/diagnosis/*epidemiology</keyword><keyword>Humans</keyword><keyword>Non-alcoholic Fatty Liver Disease</keyword><keyword>Prevalence</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2011</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1365-2036 (Electronic)
0269-2813 (Linking)</isbn><accession-num>21623852</accession-num><urls><related-urls><url>;[5]. NAFLD is usually diagnosed by detecting steatosis after excluding other causes of liver disease. However, hepatic steatosis may occur in patients with other liver diseases, often in those with obesity and other metabolic factors typical of NAFLD, potentially creating an additive or synergistic combination of steatosis, oxidative damage, cellular impairment and other factors that may worsen liver injury ADDIN EN.CITE <EndNote><Cite><Author>Powell</Author><Year>2005</Year><RecNum>15</RecNum><DisplayText><style face="superscript">[6]</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493519097">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Powell, E. E.</author><author>Jonsson, J. R.</author><author>Clouston, A. D.</author></authors></contributors><auth-address>School of Medicine, Southern Division, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia. Elizabeth_Powell@health..au</auth-address><titles><title>Steatosis: co-factor in other liver diseases</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>5-13</pages><volume>42</volume><number>1</number><keywords><keyword>Apoptosis</keyword><keyword>Carcinoma, Hepatocellular/etiology/physiopathology</keyword><keyword>Disease Progression</keyword><keyword>Fatty Liver/*etiology/physiopathology</keyword><keyword>Hepatitis C, Chronic/*complications/physiopathology</keyword><keyword>Humans</keyword><keyword>Liver Cirrhosis/etiology/physiopathology</keyword><keyword>Liver Neoplasms/etiology/physiopathology</keyword><keyword>Metabolic Syndrome X/complications/physiopathology</keyword><keyword>Obesity/*complications</keyword><keyword>Oxidative Stress</keyword></keywords><dates><year>2005</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0270-9139 (Print)
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ADDIN EN.CITE.DATA [7]. The hepatic steatosis prevalence in CHC patients has been reported to be approximately 50% (range 30%-70%) ADDIN EN.CITE <EndNote><Cite><Author>Lonardo</Author><Year>2004</Year><RecNum>3</RecNum><DisplayText><style face="superscript">[8]</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493459283">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lonardo, A.</author><author>Adinolfi, L. E.</author><author>Loria, P.</author><author>Carulli, N.</author><author>Ruggiero, G.</author><author>Day, C. P.</author></authors></contributors><auth-address>Division of Internal Medicine and Gastroenterology, Modena City Hospital, Italy. a.lonardo@libero.it</auth-address><titles><title>Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>586-97</pages><volume>126</volume><number>2</number><keywords><keyword>Arteriosclerosis/complications</keyword><keyword>Diabetes Mellitus, Type 2/complications</keyword><keyword>Disease Progression</keyword><keyword>Fatty Liver/epidemiology/therapy/*virology</keyword><keyword>Hepatitis C/*complications</keyword><keyword>Hepatitis C, Chronic/physiopathology</keyword><keyword>Humans</keyword><keyword>Liver Cirrhosis/virology</keyword><keyword>Prevalence</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0016-5085 (Print)
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ADDIN EN.CITE.DATA [9,10]. It has been proposed that HCV’s effects on hepatic lipid metabolism may inhibit the export proteins needed for the assembly and secretion of very low density lipoproteins (VLDL), resulting in triglyceride accumulation in the liver ADDIN EN.CITE <EndNote><Cite><Author>Lonardo</Author><Year>2004</Year><RecNum>3</RecNum><DisplayText><style face="superscript">[8]</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493459283">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lonardo, A.</author><author>Adinolfi, L. E.</author><author>Loria, P.</author><author>Carulli, N.</author><author>Ruggiero, G.</author><author>Day, C. P.</author></authors></contributors><auth-address>Division of Internal Medicine and Gastroenterology, Modena City Hospital, Italy. a.lonardo@libero.it</auth-address><titles><title>Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>586-97</pages><volume>126</volume><number>2</number><keywords><keyword>Arteriosclerosis/complications</keyword><keyword>Diabetes Mellitus, Type 2/complications</keyword><keyword>Disease Progression</keyword><keyword>Fatty Liver/epidemiology/therapy/*virology</keyword><keyword>Hepatitis C/*complications</keyword><keyword>Hepatitis C, Chronic/physiopathology</keyword><keyword>Humans</keyword><keyword>Liver Cirrhosis/virology</keyword><keyword>Prevalence</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0016-5085 (Print)
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ADDIN EN.CITE.DATA [11]. Historically, an SVR with interferon was not associated with steatosis resolution except in GNT3 patients which has a different steatosis etiology ADDIN EN.CITE <EndNote><Cite><Author>Bondini</Author><Year>2006</Year><RecNum>21</RecNum><DisplayText><style face="superscript">[10]</style></DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493976574">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bondini, S.</author><author>Younossi, Z. M.</author></authors></contributors><auth-address>Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.</auth-address><titles><title>Non-alcoholic fatty liver disease and hepatitis C infection</title><secondary-title>Minerva Gastroenterol Dietol</secondary-title></titles><periodical><full-title>Minerva Gastroenterol Dietol</full-title></periodical><pages>135-43</pages><volume>52</volume><number>2</number><keywords><keyword>Fatty Liver/*complications</keyword><keyword>Hepatitis C/*complications</keyword><keyword>Humans</keyword></keywords><dates><year>2006</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1121-421X (Print)
1121-421X (Linking)</isbn><accession-num>16557185</accession-num><urls><related-urls><url>;[10]. In patients with an SVR achieved with DAAs steatosis prevalence is unknown. In this prospective, cross-sectional study, we assessed steatosis prevalence and degree of fibrosis in CHC patients who achieved an SVR through treatment with DAAs. MATERIALS AND METHODSStudy designThis is a prospective, cross-sectional study of patients with CHC who achieved an SVR after treatment with DAAs. The patients in this cohort had been treated with a variety of direct-acting antiviral regimens: ledipasvir/sofosbuvir (Harvoni), 75 patients; elbasvir/grazoprevir (Zepatier), 1 patient; dasabuvir/ombitasvir/paritaprevir/ritonavir (Viekira), 7 patients; dasabuvir/ombitasvir/paritaprevir/ritonavir with ribavirin, 2 patients; sofosbuvir (Sovaldi) with ribavirin, 9 patients; sofosbuvir with daclatasvir (Daklinza), 1 patient; sofosbuvir with simeprevir (Olysio), 2 patients; sofosbuvir/velpatasvir (Epclusa), 4 patients. Between January 2016 and March 2017, 101 adult patients were enrolled, excluding patients with other liver diseases, secondary causes of steatosis (e.g., medications, excessive alcohol), and GNT3 which has a different steatosis etiology. After achieving an SVR, patients were invited to undergo standardized history and anthropometric examination, laboratory testing, and transient elastography (TE) at the California Liver Research Institute in Los Angeles. This study received approval and was done under IRB protocol CLRI-01. Ethical guidelines for human research were followed. All patients signed informed consent. Transient elastographyTE was performed using the FibroScan 502 Touch model (M Probe, XL Probe; Echosens, Paris, France) by an experienced TE-certified technician blinded to clinical data. Patients were asked to fast for at least 4 h prior to the examination. The procedure was performed in the supine position with the right arm adducted while holding the breath for 10 s. All patients were first scanned with the M probe (3.5 MHz) over the right liver lobe. If indicated by the machine, patients were re-evaluated using the XL probe (2.5 MHz). Ten measurements were made and the interquartile range was less than 30%. We defined test failure when no stiffness measurement was obtained or there were unreliable measurements (success rate < 60% or interquartile range/median > 30%)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXN0ZXJhPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48
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ADDIN EN.CITE.DATA [12-14].Liver stiffness/fibrosis scores were measured before and within one year after completion of HCV treatment with DAAs; the median time interval between treatment completion and post-SVR TE was 47 wk, with no significant difference between patients with and without steatosis. Simultaneous liver steatosis measurements were obtained using controlled attenuation parameter (CAP) values in dB/m only after SVR achievement as the technology was not available in the United States at the study’s initiation. Based on the recent large patient data meta-analysis of studies containing histology-verified CAP data for grading of steatosis that determined optimal cut-offs for CAPPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYXJsYXM8L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [15], steatosis was defined as ≥ 248 dB/M. Clinically significant stiffness was defined as ≥ 7 kilopascal (kPa)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXJrPC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [16,17]. Patients’ specificationsWe included patients if they were 18 years or older, were treated for CHC using DAAs and were able to provide informed consent. We excluded patients if they (1) had a history of significant alcohol intake within 2 years of recruitment (14 drinks/week for men or 7 drinks/week for women) as assessed by the hepatologist as well as the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire; (2) had secondary causes of fatty liver such as medications (for example, methotrexate) or other infectious causes (for example, human immunodeficiency virus); (3) had evidence of liver diseases other than hepatitis C; (4) were HCV GNT3 as it is thought to have a different underlying etiology of steatosis related to the virus (viral steatosis) and we sought to investigate this genotype separately; or (5) had cirrhosis based on imaging or FibroScan. All the following information was collected: medical history, age, sex, height, weight, body mass index (BMI), ethnic background, and vital signs. Laboratory measurementsThe biochemical tests that were measured included aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, total bilirubin, direct bilirubin, albumin, fasting glucose, hemoglobin A1c, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein. Other measurements included platelets, prothrombin time, and international normalized ratio. Statistical analysisThe chi-square test was used to compare between categorical variables, and a paired t test to compare mean differences between continuous variables. Primary and secondary comparisons within groups were calculated with paired t tests, two-tailed, independent-sample t tests, or nonparametric tests including Wilcoxon signed-rank test as applicable. A two-tailed P < 0.05 was considered statistically significant. Statistical analyses were performed with SPSS 21.ResultsPatient characteristicsBetween January 2016 and March 2017, 101 adult CHC patients who achieved SVR were enrolled. At baseline the average age for the entire cohort was 60.3 ± 10.7 years and BMI was 27.6 ± 6.9 kg/m2; 37% were Caucasian and 26% were Hispanic. The average fibrosis score was 7.4 ± 1.9 kPa. HCV genotypes were: GNT1 (85%), GNT2 (14%), and GNT4 (1%) (Table 1).Changes post-SVRChanges in the Entire Cohort: As expected, post-SVR HCV viral load was undetectable compared to prior baseline (prior to starting treatment) (0.0 ± 0.0 vs 6.2 ± 0.9 IU/m; P < 0.0001). ALT and AST decreased to normal levels post-SVR compared to baseline (17.8 ± 12.3 vs 63.1 ± 62.6 U/L for ALT; P < 0.0001 and 21.5 ± 8.0 vs 51.8 ± 41.1 U/L for AST; P < 0.0001). There was no change in BMI post-SVR compared to baseline (27.5 ± 6.9 vs 27.6 ± 6.9 kg/m2). In the overall cohort, post-SVR there was a significant decrease in fibrosis score on TE (7.4 ± 1.9 to 6.1 ± 3.6 kPa; P = 0.013), a decline that is considered clinically significant.Changes in patients with and without steatosis post-SVR: Post-SVR, 48 patients (47.5%) had steatosis with mean CAP score 296.3 37.4 compared to a mean CAP score 212.4 29.4 dB/m in patients without steatosis (P < 0.0001) (Figure 1). Patients with steatosis were more likely than patients without steatosis to have type 2 diabetes (18.7% vs 7.5%; P = 0.04), dyslipidemia (10.4% vs 5.7%; P = 0.048), higher body mass index (28.9 6.6 vs 26.1 6.9 kg/m2; P = 0.049), ALT (20.4 ± 16.5 vs 15.3 ± 5.5 U/L; P = 0.048), fasting glucose (107.8 30.5 vs 96.5 11.1 mg/dL; P = 0.023) and triglycerides (138.8 77.9 vs 109.7 63.9 mg/dL; P = 0.05) (Table 2). None of the patients without steatosis had abnormal liver enzymes; only 6.25% of patients with steatosis had abnormal liver enzymes. Changes in patients with and without steatosis between baseline and post-SVR: Interestingly, patients with steatosis continued to have clinically significant liver stiffness (mean baseline 7.7 1.7 kPa; post-SVR 7.0 4.8 kPa; P = 0.037) while patients without steatosis did not (mean baseline 7.1 2.1; post-SVR 5.3 1.5 kPa; P < 0.0001) (Table 3). Among patients with post-SVR steatosis, 6.25% had advanced fibrosis defined as ≥ 11 kPa. No patients without steatosis had advanced fibrosis (Table 3). Post-SVR, neither weight nor BMI changed while levels of transaminases and other liver enzymes dropped in patients both with and without steatosis, including ALT (55.6 ± 60.9 to 15.3 ± 5.5 U/L in patients with steatosis, P < 0.0001, and 68.78 ± 52.8 to 20.4 ± 16.5 U/L in patients without steatosis; P < 0.0001, respectively); AST (43.3 ± 35.6 to 20.2 ± 5.4 U/L; P < 0.0001 and 61.3 ± 44.7 to 22.9 ± 9.8 U/L; P < 0.0001, respectively); and alkaline phosphatase (78.5 ± 43.1 to 70.8 ± 28.8 U/L; P = 0.01 and 75.5 ± 21.8 to 71.3 ± 19.4 U/L; P = 0.04 (Table 3). DiscussionSince hepatic steatosis prevalence in CHC patients has previously been reported to be approximately 50% ADDIN EN.CITE <EndNote><Cite><Author>Lonardo</Author><Year>2004</Year><RecNum>3</RecNum><DisplayText><style face="superscript">[8]</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493459283">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lonardo, A.</author><author>Adinolfi, L. E.</author><author>Loria, P.</author><author>Carulli, N.</author><author>Ruggiero, G.</author><author>Day, C. P.</author></authors></contributors><auth-address>Division of Internal Medicine and Gastroenterology, Modena City Hospital, Italy. a.lonardo@libero.it</auth-address><titles><title>Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>586-97</pages><volume>126</volume><number>2</number><keywords><keyword>Arteriosclerosis/complications</keyword><keyword>Diabetes Mellitus, Type 2/complications</keyword><keyword>Disease Progression</keyword><keyword>Fatty Liver/epidemiology/therapy/*virology</keyword><keyword>Hepatitis C/*complications</keyword><keyword>Hepatitis C, Chronic/physiopathology</keyword><keyword>Humans</keyword><keyword>Liver Cirrhosis/virology</keyword><keyword>Prevalence</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0016-5085 (Print)
0016-5085 (Linking)</isbn><accession-num>14762795</accession-num><urls><related-urls><url>;[8] our findings of a 47.5% prevalence post-SVR achieved with DAAs should perhaps not be surprising. However, this very high prevalence with continuing clinically significant fibrosis in the steatotic patients despite normal liver enzymes should be of concern to clinicians. The current European guidelines recommend assessing ALT and HCV RNA 48 wk post-treatment in non-cirrhotic patients with SVR, with no further follow up with normal ALT/undetectable HCV RNA ADDIN EN.CITE <EndNote><Cite><Author>European Association for the Study of the Liver</Author><Year>2017</Year><RecNum>6</RecNum><DisplayText><style face="superscript">[18]</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493462016">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>European Association for the Study of the Liver,,</author></authors></contributors><titles><title>EASL recommendations on treatment of hepatitis C 2016</title><secondary-title>J Hepatol</secondary-title></titles><periodical><full-title>J Hepatol</full-title></periodical><pages>153-194</pages><volume>66</volume><number>1</number><dates><year>2017</year><pub-dates><date>January</date></pub-dates></dates><urls></urls></record></Cite></EndNote>[18]. The current United States guidelines for patients post-SVR recommend follow up only for those with advanced fibrosis; assessing other liver disease causes is only recommended in cases of persistently abnormal transaminases ADDIN EN.CITE <EndNote><Cite><Author>American Association for the Study of Liver Diseases</Author><Year>2017</Year><RecNum>5</RecNum><DisplayText><style face="superscript">[19]</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493461356">5</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>American Association for the Study of Liver Diseases,,</author><author>Infectious Diseases Society of America,,</author></authors></contributors><titles><title>Summary of the recommendations for monitoring patients who are starting HCV treatment, are on treatment, or have completed therapy</title></titles><volume>2017</volume><number>April 29</number><dates><year>2017</year><pub-dates><date>April 12, 2017</date></pub-dates></dates><urls><related-urls><url>;[19]. Importantly, we show that fatty liver may be present despite normal liver enzymes, confirming previous studies that have shown thisPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ccm93bmluZzwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+
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ADDIN EN.CITE.DATA [20]. Therefore, we recommend post-SVR assessment of steatosis and fibrosis in those with abnormal BMI or other risk factors typical of NAFLD. In patients found to have hepatic steatosis long-term follow up is warranted.To our knowledge this is the first prospective study to assess the prevalence of fatty liver in HCV patients who achieved an SVR with DAAs. We hope that our study will raise awareness of the post-SVR prevalence of fatty liver and the need for screening and long-term follow up. Our study’s strengths include the community-based hepatology setting, which likely accurately represents real life experience. In addition, we used TE, which is highly sensitive and specific, and is widely used and easy to perform. Although liver biopsy is still the gold standard to assess fatty liver and staging with MRI proton density fat fraction may be more accurate ADDIN EN.CITE <EndNote><Cite><Author>Noureddin</Author><Year>2015</Year><RecNum>7</RecNum><DisplayText><style face="superscript">[21]</style></DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493464020">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Noureddin, M.</author><author>Khoyilar, C.</author><author>Palmer, S. L.</author></authors></contributors><auth-address>Department of Medicine, Division of Gastrointestinal and Liver Diseases (for Noureddin and Khoyilar), Department of Radiology (for Palmer) USC Keck School of Medicine Los Angeles, CA.</auth-address><titles><title>MRI, CT scan, and ultrasound in the diagnosis of nonalcoholic fatty liver disease</title><secondary-title>J Clin Gastroenterol</secondary-title></titles><periodical><full-title>J Clin Gastroenterol</full-title></periodical><pages>351-2</pages><volume>49</volume><number>4</number><keywords><keyword>*Global Health</keyword><keyword>Humans</keyword><keyword>Non-alcoholic Fatty Liver Disease/*therapy</keyword></keywords><dates><year>2015</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1539-2031 (Electronic)
0192-0790 (Linking)</isbn><accession-num>25551206</accession-num><urls><related-urls><url>;[21], biopsy is invasive and costly and many patients are reluctant to undergo the procedure because of concerns about pain and, although limited, possible complications. With biopsy there is also the possibility of inter-and intra-observer variability and sampling error ADDIN EN.CITE <EndNote><Cite><Author>Zeng</Author><Year>2016</Year><RecNum>44</RecNum><DisplayText><style face="superscript">[22]</style></DisplayText><record><rec-number>44</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1497923234">44</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Zeng, D. W.</author><author>Dong, J.</author><author>Liu, Y. R.</author><author>Jiang, J. J.</author><author>Zhu, Y. Y.</author></authors></contributors><auth-address>Da-Wu Zeng, Jing Dong, Yu-Rui Liu, Jia-Ji Jiang, Yue-Yong Zhu, Liver Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China.</auth-address><titles><title>Noninvasive models for assessment of liver fibrosis in patients with chronic hepatitis B virus infection</title><secondary-title>World J Gastroenterol</secondary-title></titles><periodical><full-title>World J Gastroenterol</full-title></periodical><pages>6663-72</pages><volume>22</volume><number>29</number><keywords><keyword>Fibrosis</keyword><keyword>Hepatitis B</keyword><keyword>Liver biopsy</keyword><keyword>Noninvasive</keyword><keyword>Serum biomarkers</keyword></keywords><dates><year>2016</year><pub-dates><date>Aug 07</date></pub-dates></dates><isbn>2219-2840 (Electronic)
1007-9327 (Linking)</isbn><accession-num>27547009</accession-num><urls><related-urls><url>;[22]. MRI techniques are quite expensive. Neither of these is likely to be performed in post-SVR patients with normal liver enzymes. Thus, the use of TE with CAP is realistic in a real-world setting.There is substantial data showing good sensitivity and specificity for the use of TE in determining either presence of advanced fibrosis or no fibrosis. In eight studies that compared the usefulness of TE and liver biopsy for assessment of liver fibrosis in NAFLD patients it was shown that TE is very good for diagnosis of F ≥ 3, with 84%-100% sensitivity and 83%-97% specificityPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNzaW5vdHRvPC9BdXRob3I+PFllYXI+MjAxNjwvWWVh
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ADDIN EN.CITE.DATA [23-30]. Similar findings were reported in a recent large systematic review and meta-analysis that confirmed that TE was excellent for diagnosis of F ≥ 3 in NAFLD patients ADDIN EN.CITE <EndNote><Cite><Author>Kwok</Author><Year>2014</Year><RecNum>42</RecNum><DisplayText><style face="superscript">[31]</style></DisplayText><record><rec-number>42</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1497696470">42</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kwok, R.</author><author>Tse, Y. K.</author><author>Wong, G. L.</author><author>Ha, Y.</author><author>Lee, A. U.</author><author>Ngu, M. C.</author><author>Chan, H. L.</author><author>Wong, V. W.</author></authors></contributors><auth-address>Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Gastroenterology and Hepatology, Concord Repatriation Hospital, Sydney, Australia.</auth-address><titles><title>Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease--the role of transient elastography and plasma cytokeratin-18 fragments</title><secondary-title>Aliment Pharmacol Ther</secondary-title></titles><periodical><full-title>Aliment Pharmacol Ther</full-title></periodical><pages>254-69</pages><volume>39</volume><number>3</number><keywords><keyword>Biomarkers/metabolism</keyword><keyword>Biopsy</keyword><keyword>Elasticity Imaging Techniques/*methods</keyword><keyword>Fatty Liver/*diagnosis/pathology</keyword><keyword>Humans</keyword><keyword>Keratin-18/*blood</keyword><keyword>Liver Cirrhosis/diagnosis/pathology</keyword><keyword>Non-alcoholic Fatty Liver Disease</keyword><keyword>Obesity/complications</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2014</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1365-2036 (Electronic)
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ADDIN EN.CITE.DATA [32]. Although cutoff values for defining steatosis with CAP have not been fully formalized, we chose the value that defined steatosis (≥ 248 dB/M) based on a very recent large (2735 patients) meta-analysis of studies containing histology-verified CAP data for grading of steatosis that determined optimal cut-offs for CAPPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYXJsYXM8L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [15]. Although until relatively recently, obesity (BMI > 30 kg/m2) was associated with a reduced ability of TE to accurately determine fibrosis and steatosis, this problem has been largely addressed with the development of the obese-specific XL probe which we used in our study, confirmed in multiple studies to obtain reliable liver stiffness measurement in obese patientsPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NaWtvbGFzZXZpYzwvQXV0aG9yPjxZZWFyPjIwMTY8L1ll
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ADDIN EN.CITE.DATA [33-35]. Another strength of our study is our inclusion of a detailed metabolic profile and alcohol questionnaire, with other causes carefully ruled out. It has been suggested that post-SVR some patients might feel free to indulge in alcohol consumption, with a resulting increase in liver stiffness measurements. Importantly, we ruled out increased alcohol intake through both medical records and use of the AUDIT-C at the time of the TE CAP assessment post-SVR. Although our exclusion of HCV GNT3 patients means that our findings cannot be applied to the approximately 30.1% of HCV patients with this genotype ADDIN EN.CITE <EndNote><Cite><Author>Messina</Author><Year>2015</Year><RecNum>49</RecNum><DisplayText><style face="superscript">[36]</style></DisplayText><record><rec-number>49</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1497945779">49</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Messina, J. P.</author><author>Humphreys, I.</author><author>Flaxman, A.</author><author>Brown, A.</author><author>Cooke, G. S.</author><author>Pybus, O. G.</author><author>Barnes, E.</author></authors></contributors><auth-address>Spatial Epidemiology and Ecology Group, Department of Zoology, University of Oxford, Oxford, UK.</auth-address><titles><title>Global distribution and prevalence of hepatitis C virus genotypes</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>77-87</pages><volume>61</volume><number>1</number><keywords><keyword>Genotype</keyword><keyword>Hepacivirus/*genetics</keyword><keyword>Hepatitis C/epidemiology/*virology</keyword><keyword>Humans</keyword><keyword>Internationality</keyword><keyword>Prevalence</keyword></keywords><dates><year>2015</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>25069599</accession-num><urls><related-urls><url>;[36], the exclusion is a strength of the study in other ways. Steatosis has been shown to correlate with intrahepatic viral replication in GNT3, with resolution of steatosis seen after effective antiviral treatment, suggesting a direct steatogenic effect of GNT3 virus ADDIN EN.CITE <EndNote><Cite><Author>Lonardo</Author><Year>2004</Year><RecNum>3</RecNum><DisplayText><style face="superscript">[8]</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493459283">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lonardo, A.</author><author>Adinolfi, L. E.</author><author>Loria, P.</author><author>Carulli, N.</author><author>Ruggiero, G.</author><author>Day, C. P.</author></authors></contributors><auth-address>Division of Internal Medicine and Gastroenterology, Modena City Hospital, Italy. a.lonardo@libero.it</auth-address><titles><title>Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>586-97</pages><volume>126</volume><number>2</number><keywords><keyword>Arteriosclerosis/complications</keyword><keyword>Diabetes Mellitus, Type 2/complications</keyword><keyword>Disease Progression</keyword><keyword>Fatty Liver/epidemiology/therapy/*virology</keyword><keyword>Hepatitis C/*complications</keyword><keyword>Hepatitis C, Chronic/physiopathology</keyword><keyword>Humans</keyword><keyword>Liver Cirrhosis/virology</keyword><keyword>Prevalence</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0016-5085 (Print)
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ADDIN EN.CITE.DATA [37]. In a study that compared the effects of interferon treatment in GNT1 and GNT3 patients, hepatic steatosis did not change in GNT1 patients, regardless of the treatment response, while steatosis was significantly reduced in GNT3 patients who achieved an SVR (P < 0.001) but not in patients who did not ADDIN EN.CITE <EndNote><Cite><Author>Kumar</Author><Year>2002</Year><RecNum>12</RecNum><DisplayText><style face="superscript">[38]</style></DisplayText><record><rec-number>12</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1493468666">12</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kumar, D.</author><author>Farrell, G. C.</author><author>Fung, C.</author><author>George, J.</author></authors></contributors><auth-address>Storr Liver Unit, Westmead Millennium Institute, University of Sydney, Australia.</auth-address><titles><title>Hepatitis C virus genotype 3 is cytopathic to hepatocytes: Reversal of hepatic steatosis after sustained therapeutic response</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1266-72</pages><volume>36</volume><number>5</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Antiviral Agents/therapeutic use</keyword><keyword>Biopsy</keyword><keyword>Fatty Liver/drug therapy/pathology/*virology</keyword><keyword>Female</keyword><keyword>Genotype</keyword><keyword>Hepacivirus/*genetics</keyword><keyword>Hepatitis C, Chronic/drug therapy/*pathology</keyword><keyword>Hepatocytes/*pathology/*virology</keyword><keyword>Humans</keyword><keyword>Longitudinal Studies</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Predictive Value of Tests</keyword></keywords><dates><year>2002</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0270-9139 (Print)
0270-9139 (Linking)</isbn><accession-num>12395339</accession-num><urls><related-urls><url>;[38], again suggesting a direct steatogenic effect of GNT3 HCV. Thus, GNT3 patients represent a unique population in terms of steatosis that should be studied separately. Inclusion of these patients in our study could have substantially altered our findings regarding post-SVR steatosis, likely substantially reducing the prevalence due to steatosis reduction in GNT3 patients, resulting in an overall steatosis prevalence which would not be representative of the almost 70% of HCV patients with other genotypes ADDIN EN.CITE <EndNote><Cite><Author>Messina</Author><Year>2015</Year><RecNum>49</RecNum><DisplayText><style face="superscript">[36]</style></DisplayText><record><rec-number>49</rec-number><foreign-keys><key app="EN" db-id="awsaawttp90ptre59sgpf2vmwz2vzrtpze0s" timestamp="1497945779">49</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Messina, J. P.</author><author>Humphreys, I.</author><author>Flaxman, A.</author><author>Brown, A.</author><author>Cooke, G. S.</author><author>Pybus, O. G.</author><author>Barnes, E.</author></authors></contributors><auth-address>Spatial Epidemiology and Ecology Group, Department of Zoology, University of Oxford, Oxford, UK.</auth-address><titles><title>Global distribution and prevalence of hepatitis C virus genotypes</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>77-87</pages><volume>61</volume><number>1</number><keywords><keyword>Genotype</keyword><keyword>Hepacivirus/*genetics</keyword><keyword>Hepatitis C/epidemiology/*virology</keyword><keyword>Humans</keyword><keyword>Internationality</keyword><keyword>Prevalence</keyword></keywords><dates><year>2015</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>25069599</accession-num><urls><related-urls><url>;[36].A limitation of our study is that, because the CAP technology was not available in the United States at the time of study initiation, we were unable to estimate steatosis prevalence with CAP prior to the initiation of DAAs in order to determine treatment effect. However, regardless of baseline steatosis prevalence, there is real clinical value in assessing post-SVR prevalence so that appropriate long-term follow up can be recommended. Another limitation is the length of follow-up as the median time interval in our study is 47 wk between treatment completion and the post-SVR TE. Lengthier studies are definitely needed to assess NAFLD progression and steatosis and fibrosis changes over time in this population. However, by assessing patients at almost a year post-SVR we have at least provided a foundation upon which lengthier studies could expand. The sample size could be considered as a limitation; however, this is a proof of concept study that this is first of its kind and warrants larger studies. Finally, we excluded patients with cirrhosis. However, these patients are usually followed up closely post-SVR and steatosis has been found to be low when patients have advanced fibrosisPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZXJtdXR0PC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48
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ADDIN EN.CITE.DATA [40,41]. We propose revisiting this and implementing new definitions of those with concomitant liver diseases, including those with HCV SVRs, that might allow patients’ participation in trials, an unmet need in the rising epidemic of NAFLD.Article Highlights Research backgroundIt is known that the hepatic steatosis prevalence in hepatitis C patients who have achieved a sustained virological response with interferon is approximately 50%. However, the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals has not previously been studied. Knowledge of this is important in order to direct appropriate long-term follow up for patients. Research motivationPost-sustained virological response (SVR), hepatitis C patients, many of whom have normal liver enzymes, are too often being discharged from their hepatologists’ care with no further plans for follow up. The current European and United States guidelines only recommend long-term follow up in patients with elevated enzymes. In addition, many hepatitis C patients who have achieved an SVR are excluded from nonalcoholic fatty liver disease (NAFLD) clinical trials. We think it is important to determine the prevalence of NAFLD post-SVR and assess the severity of liver disease in these patients. Determining these things can provide a basis for future research aimed at determining the long-term natural history of the disease in these patients, and may prompt changes in both liver society guidelines for follow up and in clinical trial exclusion criteria. Research objectivesThe main objective, to determine the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals, was achieved. This knowledge provides a basis for future research aimed at determining the long-term natural history of the disease in these patients.Research methodsIn this study we used transient elastography with controlled attenuation parameter to measure steatosis and fibrosis in hepatitis C patients post-SVR. This was the first study to measure both fibrosis and steatosis in hepatitis C patients using the FibroScan technology.Research resultsOur findings have added knowledge previously unknown in this field that may help to guide the need for long-term monitoring of hepatitis C patients post-SVR, with a particular focus on the possible occurrence of NAFLD in these patients, whether or not there are elevated liver enzymes. The most important future research will be to carry out long-term follow up on hepatitis C patients post-SVR to determine the prevalence of fatty liver over time. Research conclusionsThis is the first prospective study to assess the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals. The study’s findings that fatty liver is present in 47.5% of these patients and that some steatotic patients have clinically significant fibrosis despite normal liver enzymes should raise awareness of the high post-SVR prevalence of fatty liver and the importance of post-SVR assessment of steatosis and fibrosis and long-term follow up with these patients. The study’s findings raise concern that the recommendations found in the current U.S. and European guidelines for follow up of patients post-SVR could result in a lack of adequate long-term monitoring of these patients. In particular, the very high prevalence of fatty liver (47.5%) with continuing clinically significant fibrosis in the steatotic patients despite normal liver enzymes should be of concern to clinicians. Therefore, we recommend post-SVR assessment of steatosis and fibrosis in those with abnormal BMI or other risk factors typical of NAFLD. In patients found to have hepatic steatosis long-term follow up is clearly warranted.Research perspectivesOur study’s assessment of steatosis and fibrosis in hepatitis C patients at almost a year post-SVR has shown that long-term monitoring of these patients to assess the possibility of fatty liver and fibrosis is important. With this study, we have provided a foundation upon which lengthier and larger studies should expand, using regularly scheduled transient elastography with controlled attenuation parameter assessments in order to determine whether this high level of steatosis is still present multiple years post-SVR and the clinical ramifications for patients. References1 Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64: 73-84 [PMID: 26707365 DOI: 10.1002/hep.28431]2 World Health Organization. Global hepatitis report 2017. Geneva, Switzerland: World Health Organization, 2017: 833 Setiawan VW, Stram DO, Porcel J, Lu SC, Le Marchand L, Noureddin M. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort. Hepatology 2016; 64: 1969-1977 [PMID: 27301913 DOI: 10.1002/hep.28677]4 Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, Ahmed A. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 2015; 148: 547-555 [PMID: 25461851 DOI: 10.1053/j.gastro.2014.11.039]5 Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011; 34: 274-285 [PMID: 21623852 DOI: 10.1111/j.1365-2036.2011.04724.x]6 Powell EE, Jonsson JR, Clouston AD. Steatosis: co-factor in other liver diseases. Hepatology 2005; 42: 5-13 [PMID: 15962320 DOI: 10.1002/hep.20750]7 Adinolfi LE, Gambardella M, Andreana A, Tripodi MF, Utili R, Ruggiero G. 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 [PMID: 11391523 DOI: 10.1053/jhep.2001.24432]8 Lonardo A, Adinolfi LE, Loria P, Carulli N, Ruggiero G, Day CP. Steatosis and hepatitis C virus: mechanisms and significance for hepatic and extrahepatic disease. Gastroenterology 2004; 126: 586-597 [PMID: 14762795]9 Castera L. Steatosis, insulin resistance and fibrosis progression in chronic hepatitis C. Minerva Gastroenterol Dietol 2006; 52: 125-134 [PMID: 16557184]10 Bondini S, Younossi ZM. Non-alcoholic fatty liver disease and hepatitis C infection. Minerva Gastroenterol Dietol 2006; 52: 135-143 [PMID: 16557185]11 Abenavoli L, Masarone M, Peta V, Milic N, Kobyliak N, Rouabhia S, Persico M. Insulin resistance and liver steatosis in chronic hepatitis C infection genotype 3. World J Gastroenterol 2014; 20: 15233-15240 [PMID: 25386071 DOI: 10.3748/wjg.v20.i41.15233]12 Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol 2008; 48: 835-847 [PMID: 18334275 DOI: 10.1016/j.jhep.2008.02.008]13 Han MA, Saouaf R, Ayoub W, Todo T, Mena E, Noureddin M. Magnetic resonance imaging and transient elastography in the management of Nonalcoholic Fatty Liver Disease (NAFLD). Expert Rev Clin Pharmacol 2017; 10: 379-390 [PMID: 28277807 DOI: 10.1080/17512433.2017.1299573]14 Rinella ME, Sanyal AJ. Management of NAFLD: a stage-based approach. Nat Rev Gastroenterol Hepatol 2016; 13: 196-205 [PMID: 26907882 DOI: 10.1038/nrgastro.2016.3]15 Karlas T, Petroff D, Sasso M, Fan JG, Mi YQ, de Lédinghen V, Kumar M, Lupsor-Platon M, Han KH, Cardoso AC, Ferraioli G, Chan WK, Wong VW, Myers RP, Chayama K, Friedrich-Rust M, Beaugrand M, Shen F, Hiriart JB, Sarin SK, Badea R, Jung KS, Marcellin P, Filice C, Mahadeva S, Wong GL, Crotty P, Masaki K, Bojunga J, Bedossa P, Keim V, Wiegand J. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol 2017; 66: 1022-1030 [PMID: 28039099 DOI: 10.1016/j.jhep.2016.12.022]16 Park CC, Nguyen P, Hernandez C, Bettencourt R, Ramirez K, Fortney L, Hooker J, Sy E, Savides MT, Alquiraish MH, Valasek MA, Rizo E, Richards L, Brenner D, Sirlin CB, Loomba R. Magnetic Resonance Elastography vs Transient Elastography in Detection of Fibrosis and Noninvasive Measurement of Steatosis in Patients With Biopsy-Proven Nonalcoholic Fatty Liver Disease. Gastroenterology 2017; 152: 598-607 [PMID: 27911262 DOI: 10.1053/j.gastro.2016.10.026]17 Alkhouri N, Feldstein AE. Noninvasive diagnosis of nonalcoholic fatty liver disease: Are we there yet? Metabolism 2016; 65: 1087-1095 [PMID: 26972222 DOI: 10.1016/j.metabol.2016.01.013]18 European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2016. J Hepatol 2017; 66: 153-194 [PMID: 27667367 DOI: 10.1016/j.jhep.2016.09.001]19 American Association for the Study of Liver Diseases, Infectious Diseases Society of America. Summary of the recommendations for monitoring patients who are starting HCV treatment, are on treatment, or have completed therapy. Available from: URL: Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004; 40: 1387-1395 [PMID: 15565570 DOI: 10.1002/hep.20466]21 Noureddin M, Khoyilar C, Palmer SL. MRI, CT scan, and ultrasound in the diagnosis of nonalcoholic fatty liver disease. J Clin Gastroenterol 2015; 49: 351-352 [PMID: 25551206 DOI: 10.1097/MCG.0000000000000281]22 Zeng DW, Dong J, Liu YR, Jiang JJ, Zhu YY. Noninvasive models for assessment of liver fibrosis in patients with chronic hepatitis B virus infection. World J Gastroenterol 2016; 22: 6663-6672 [PMID: 27547009 DOI: 10.3748/wjg.v22.i29.6663]23 Cassinotto C, Boursier J, de Lédinghen V, Lebigot J, Lapuyade B, Cales P, Hiriart JB, Michalak S, Bail BL, Cartier V, Mouries A, Oberti F, Fouchard-Hubert I, Vergniol J, Aubé C. Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy. Hepatology 2016; 63: 1817-1827 [PMID: 26659452 DOI: 10.1002/hep.28394]24 Imajo K, Kessoku T, Honda Y, Tomeno W, Ogawa Y, Mawatari H, Fujita K, Yoneda M, Taguri M, Hyogo H, Sumida Y, Ono M, Eguchi Y, Inoue T, Yamanaka T, Wada K, Saito S, Nakajima A. Magnetic Resonance Imaging More Accurately Classifies Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease Than Transient Elastography. Gastroenterology 2016; 150: 626-637 [PMID: 26677985 DOI: 10.1053/j.gastro.2015.11.048]25 Kumar R, Rastogi A, Sharma MK, Bhatia V, Tyagi P, Sharma P, Garg H, Chandan Kumar KN, Bihari C, Sarin SK. Liver stiffness measurements in patients with different stages of nonalcoholic fatty liver disease: diagnostic performance and clinicopathological correlation. Dig Dis Sci 2013; 58: 265-274 [PMID: 22790906 DOI: 10.1007/s10620-012-2306-1]26 Lupsor M, Badea R, Stefanescu H, Grigorescu M, Serban A, Radu C, Cri?an D, Sparchez Z, Iancu S, Maniu A. Performance of unidimensional transient elastography in staging non-alcoholic steatohepatitis. J Gastrointestin Liver Dis 2010; 19: 53-60 [PMID: 20361076]27 Pathik P, Ravindra S, Ajay C, Prasad B, Jatin P, Prabha S. Fibroscan versus simple noninvasive screening tools in predicting fibrosis in high-risk nonalcoholic fatty liver disease patients from Western India. Ann Gastroenterol 2015; 28: 281-286 [PMID: 25830783]28 Wong VW, Vergniol J, Wong GL, Foucher J, Chan HL, Le Bail B, Choi PC, Kowo M, Chan AW, Merrouche W, Sung JJ, de Lédinghen V. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology 2010; 51: 454-462 [PMID: 20101745 DOI: 10.1002/hep.23312]29 Yoneda M, Yoneda M, Fujita K, Inamori M, Tamano M, Hiriishi H, Nakajima A. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut 2007; 56: 1330-1331 [PMID: 17470477 DOI: 10.1136/gut.2007.126417]30 Yoneda M, Yoneda M, Mawatari H, Fujita K, Endo H, Iida H, Nozaki Y, Yonemitsu K, Higurashi T, Takahashi H, Kobayashi N, Kirikoshi H, Abe Y, Inamori M, Kubota K, Saito S, Tamano M, Hiraishi H, Maeyama S, Yamaguchi N, Togo S, Nakajima A. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis 2008; 40: 371-378 [PMID: 18083083 DOI: 10.1016/j.dld.2007.10.019]31 Kwok R, Tse YK, Wong GL, Ha Y, Lee AU, Ngu MC, Chan HL, Wong VW. Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease--the role of transient elastography and plasma cytokeratin-18 fragments. Aliment Pharmacol Ther 2014; 39: 254-269 [PMID: 24308774 DOI: 10.1111/apt.12569]32 Noureddin M, Mato JM, Lu SC. Nonalcoholic fatty liver disease: update on pathogenesis, diagnosis, treatment and the role of S-adenosylmethionine. Exp Biol Med (Maywood) 2015; 240: 809-820 [PMID: 25873078 DOI: 10.1177/1535370215579161]33 Mikolasevic I, Orlic L, Franjic N, Hauser G, Stimac D, Milic S. Transient elastography (FibroScan(?)) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand? World J Gastroenterol 2016; 22: 7236-7251 [PMID: 27621571 DOI: 10.3748/wjg.v22.i32.7236]34 Myers RP, Pomier-Layrargues G, Kirsch R, Pollett A, Duarte-Rojo A, Wong D, Beaton M, Levstik M, Crotty P, Elkashab M. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology 2012; 55: 199-208 [PMID: 21898479 DOI: 10.1002/hep.24624]35 Sporea I, ?irli R, Mare R, Popescu A, Iva?cu SC. Feasibility of Transient Elastography with M and XL probes in real life. Med Ultrason 2016; 18: 7-10 [PMID: 26962547 DOI: 10.11152/mu.2013.2066.181.xsi]36 Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, Barnes E. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 2015; 61: 77-87 [PMID: 25069599 DOI: 10.1002/hep.27259]37 Castéra L, Hézode C, Roudot-Thoraval F, Lonjon I, Zafrani ES, Pawlotsky JM, Dhumeaux D. Effect of antiviral treatment on evolution of liver steatosis in patients with chronic hepatitis C: indirect evidence of a role of hepatitis C virus genotype 3 in steatosis. Gut 2004; 53: 420-424 [PMID: 14960527]38 Kumar D, Farrell GC, Fung C, George J. Hepatitis C virus genotype 3 is cytopathic to hepatocytes: Reversal of hepatic steatosis after sustained therapeutic response. Hepatology 2002; 36: 1266-1272 [PMID: 12395339 DOI: 10.1053/jhep.2002.36370]39 Permutt Z, Le TA, Peterson MR, Seki E, Brenner DA, Sirlin C, Loomba R. Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol Ther 2012; 36: 22-29 [PMID: 22554256 DOI: 10.1111/j.1365-2036.2012.05121.x]40 Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ; American Gastroenterological Association; American Association for the Study of Liver Diseases; American College of Gastroenterologyh. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142: 1592-1609 [PMID: 22656328 DOI: 10.1053/j.gastro.2012.04.001]41 European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64: 1388-1402 [PMID: 27062661 DOI: 10.1016/j.jhep.2015.11.004]P-Reviewer: Abenavoli L, Ho SB,Rodriguez-Frias F S-Editor: Wang XJL-Editor: E-Editor:Specialty type: Gastroenterology and hepatologyCountry of origin: United StatesPeer-review report classificationGrade A (Excellent): 0Grade B (Very good): B, BGrade C (Good): CGrade D (Fair): 0Grade E (Poor): 0Figure 1 Post-sustained virological response steatosis prevalence in hepatitis C virus patients and advanced fibrosis prevalence in those with and without steatosis. SVR: Sustained virological response; CAP: Controlled attenuation parameter.Table 1 Demographic and clinical characteristics of the chronic hepatitis C patients prior to direct-acting antivirals treatment and after achieving sustained virological response 12 n (%)Prior to DAAtreatment (Baseline)Post-SVR12P1DemographicsMale49 (48)49 (48)NSAge (yr, mean ± SD) 60.3 ± 10.760.3 ± 10.7NSWhite37 (37)37 (37)NSHispanic26 (26)26 (26)NSAfrican American13 (13)13 (13)NSAsian7 (7)7 (7)NSOther2 (2)2 (2)NSDeclinedClinical16 (15)16 (15)NSHypertension 45 (43)45 (43)NSType 2 diabetes13 (12.3)13 (12.3)NSDyslipidemia8 (7.5)8 (7.5)NSAnthropometric (mean ± SD)Body mass index (kg/m2) 27.6 ± 6.927.5 ± 6.9NSWeight (Lbs.) 174.9 ± 46.9172.7 ± 44.5NSLaboratory panel (mean ± SD)HCV vial load log 10 IU/mL6.2 ± 0.90.0 ± 0.0< 0.0001HCV genotypeGenotype 186 (85)Genotype 215 (14)Genotype 41 (1)AST (U/L) 51.8 ± 41.121.5 ± 8.0< 0.0001ALT (U/L) 63.1 ± 62.617.8 ± 12.3< 0.0001Alkaline phosphatase (U/L) 77.5 ± 34.071.0 ± 24.30.004Albumin (g/dL) 4.3 ± 0.44.4 ± 0.4NSBilirubin, total (mg/dL) 0.6 ± 0.20.6 ± 0.3NSFasting glucose (mg/dL)99.1 ± 30.1102.1 ± 23.5NSFibroScan (mean ± SD)Fibrosis Score (kPa) 7.4 ± 1.96.1 ± 3.60.013IQR (%)12.6 ± 4.912.3 ± 5.5NS1P values (2-sided) determined from either a Fisher’s exact test for categorical variables or t-test for continuous variables. DAA: Direct-acting antivirals; SVR: Sustained virological response; HCV: Hepatitis C virus; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; IQR: Interquartile range.Table 2 Characteristics of chronic hepatitis C patients after achieving sustained virological response 12 comparing those with and without steatosis n (%)Patients without Steatosis(CAP < 248 dB/m)(n = 53)Patients with Steatosis(CAP ≥ 248 dB/m)(n = 48)P1DemographicsMale25 (47)27 (56)NSAge (yr, mean ± SD) 59.4 ± 11.660.9 ± 9.4NSWhite18 (34)18 (38)NSHispanic14 (26)12 (25)NSClinical Hypertension 25 (47.2)20 (41.7)NSDyslipidemia3 (5.7)5 (10.4)0.048Type 2 diabetes4 (7.5)9 (18.7)0.04Anthropometric (mean ± SD)Body mass index (kg/m2) 26.1 ± 6.928.9 ± 6.60.049Weight (Lbs.) 161.0 ± 33.4172.7 ± 44.50.005Hepatology and viral hepatitis panel (mean ± SD)AST (U/L) 20.2 ± 5.422.9 ± 9.8NSALT (U/L) 15.3 ± 5.520.4 ± 16.50.048Alkaline phosphatase (U/L) 70.7 ± 28.271.3 ± 19.4NSAlbumin (g/dL) 4.3 ± 0.24.5 ± 0.6NSBilirubin, total (mg/dL)0.6 ± 0.30.6 ± 0.2NSOther laboratory studies (mean ± SD)Total cholesterol (mg/dL) 184.8 ± 35.1179 ± 37.2NSHDL cholesterol (mg/dL) 57.6 ± 18.650.8 ± 17.0NSLDL cholesterol (mg/dL) 102.6 ± 33.2100.7 ± 31.5NSTriglycerides (mg/dL) 109.7 ± 63.9138.9 ± 77.90.05HbA1c (%) 5.7 ± 0.66.0 ± 0.9NSFasting serum glucose (mg/dL) 96.5 ± 11.1107.8 ± 30.50.023FibroScan (mean ±SD)Fibrosis Score (kPa) 5.3 ± 1.67.0 ± 4.80.0013CAP (dB/m)212.4 ± 29.0296.3 ± 37.4< 0.0001% of Patient withfibrosis score of (≥ 7 kPa)0%6.25%0.0661P values (2-sided) determined from either a Fisher’s exact test for categorical variables or t-test for continuous variables. CAP: Controlled attenuation parameter; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; HDL: High density lipoprotein; LDL: Low density lipoprotein; CAP: Controlled attenuation parameter.Table 3 Comparison of pre-treatment vs post-sustained virological response characteristics in patients with and without post-sustained virological response steatosisPatients without steatosis n = 53Patients with steatosis n = 48PretreatmentPost SVRPPretreatmentPost SVRPBody mass index (kg/m2)25.5 ± 4.026.1 ± 6.9NS30.0 ± 8.529.0 ± 6.6NSWeight (Lbs.)161.9 ± 32.6161.0 ± 33.4NS187.3 ± 55.8186.1 ± 51.3NSLaboratory panel (mean ± SD)HCV vial load log10 IU/mL6.1 ± 1.00.0 ± 0.0< 0.00016.3 ± 0.80.0 ± 0.0< 0.0001AST (U/L)43.3 ± 35.620.2 ± 5.4< 0.000161.3 ± 44.722.9 ± 9.8< 0.0001ALT (U/L)55.6 ± 60.915.3 ± 5.5< 0.000168.78 ± 52.820.4 ± 16.5< 0.0001Alkaline phosphatase (U/L)78.5 ± 43.170.8 ± 28.80.0175.5 ± 21.871.3 ± 19.40.04Albumin (g/dL)4.2 ± 0.54.4 ± 0.30.0064.3 ± 0.24.5 ± 0.60.006Bilirubin total (mg/dL)0.6 ± 0.20.6 ± 0.3NS0.6 ± 0.30.6 ± 0.2NSFasting glucose (mg/dL)95.6 ± 31.996.6 ± 11.1NS103.0 ± 27.5107.8 ± 30.5NSFibroScan (mean ± SD)Fibrosis score (kPa)7.1 ± 2.15.3 ± 1.5< 0.00017.7 ± 1.77.0 ± 4.80.0037SVR: Sustained virological response; HCV: Hepatitis C virus; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase. ................
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