Chronic HCV and steatosis

As the treatment of hepatitis C virus (HCV) has evolved from interferon monotherapy to current standard of care (SOC) therapy with pegylated interferon and ribavirin, sustained virologic response (SVR) rates have improved to near 50%. However, this still has left a large number of patients waiting for better treatments and significant hope resting on direct acting antiviral (DAA) therapy for HCV. The role of hepatic steatosis and insulin resistance (IR) in this treatment evolution is complex. HCV can directly lead to hepatic steatosis and IR, although viral replication, proliferation, and response to therapy are equally affected by the presence of hepatic steatosis and IR. This is particularly relevant in the face of a global obesity epidemic and new evidence that even with DAA therapy, 25–40% of patients elude SVR. This chapter focuses on the relationship of hepatic steatosis and IR to the HCV, particularly as it pertains to treatment response to past, present, and future treatment regimens.