Objective: We examined weight changes during chronic hepatitis C (CHC) therapy and association with virologic response.Methods: Weight changes were compared between subjects achieving rapid, early, and sustained virologic response rates (RVR, EVR, and SVR). RVR, EVR and SVR were compared among patients with or without weight loss of ≥ 0.5 body mass index (BMI) units (kg/m2) at 4, 12, 48 weeks.Results: CHC therapy was initiated in 184 cases. Median pretreatment BMI was 27.7 (18.4-51.3) with 38% overweight and 31% obese (BMI ≥25 and ≥ 30, respectively). Among patients with liver biopsies (n = 90), steatosis was present in 31.6%; fibrosis grade of 1-2/6 in 46%, 3-4 in 37.3% and 5-6 in 14.7%. Mean weight loss at 4, 12, 24 and 48 weeks of therapy were 1.2, 2.6, 3.8 and 3.3 kg, respectively. After 4 and 12 weeks of treatment, 38% and 54.3% had a BMI decrement of ≥ 0.5 kg/m2. For genotype 1, weight loss at 4 weeks was associated with significantly higher EVR (90.0% vs. 70%, p = 0.01) and a tendency towards better RVR and SVR (42.9% vs. 26.0% and 55.2% vs. 34.8%, respectively, p = 0.08). In multivariate analysis, weight loss at 4 weeks was independently associated with EVR (OR 6.3, p = 0.02) but was not significantly associated with RVR or SVRConclusions: Spontaneous weight loss at 4 and 12 weeks of CHC therapy was associated with improved EVR. Weight loss at 4 weeks was an independent predictor of EVR but not SVR.

BackgroundObesity is a modifiable risk factor for nonresponse to chronic hepatitis C (CHC) treatment. We examined whether weight loss during pegylated interferon (IFN) plus Ribavirin therapy is associated with improved response. Patients and methods Rapid virological response, early virological response, end of treatment response, and sustained virological response (SVR) were compared among patients with or without weight loss [Z 0.5 body mass index (BMI)] during therapy for hepatitis C virus. ResultsAmong 324, who provided consent, 280 were treatment-naive patients and 200 started pegylated-IFN/Ribavirin therapy and were included in the study. Median pretreatment BMI was 28.8 ± 5.7 (19.9-48.9) with 42.6% overweight and 31.6% obese (BMI 25-30 and Z 30, respectively). Hepatitis C virus genotype 1 was the prevalent genotype among the candidates of this study, affecting 99 cases of 136 (72.7%), whereas genotypes 2/3 affected 37 cases (27.3%). For genotype 1, weight loss at 1 and 3 months was associated with higher SVR rates (59.5 vs. 36.8% at 1 month and 55.2 vs. 34.1% at 3 months, respectively, P values = 0.02 and 0.03, respectively). Hepatic fibrosis, elevation of high-density lipoprotein, and decline of homeostasis model of assessment-insulin resistance at 6-months follow-up were proven to be independent predictors for SVR. ConclusionWeight loss during the first 6 months of IFN therapy was associated with improved SVR in patients with CHC genotype 1 rather than genotypes 2/3. Molecular changes associated with weight loss during CHC and its relation with treatment response need to be prospectively examined.

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