Chronic Hepatitis C: Treatment, Complications, and Long-term Outcomes in a Population of Latino Veterans.

OBJECTIVE: Chronic hepatitis C (CHC) is a major public health problem in Puerto Rico. It is the most common cause of chronic liver disease and the most frequent indication for liver transplantation in the United States. Our main objectives were to estimate the seroprevalence of CHC infection, to describe the demographic and histological parameters of the infection in our sample population, and to evaluate the treatment outcomes in Puerto Rican veterans. METHODS: To determine overall seroprevalence, we reviewed all the hepatitis C cases (encompassing from January 1, 2002, to December 31, 2009) of the VA Caribbean Healthcare System, Department of Veterans Affairs. The records of only those individuals who received treatment with pegylated interferon and ribavirin were reviewed to determine risks factors for infection, response rates, adverse events, and outcomes. RESULTS: During the study period, there were a total of 1,496 patients identified as being infected with HCV, for an estimated seroprevalence of 2.3%. Of these, approximately 10% (137) were treated with combination therapy and were included in this study. The mean age was 58 (±6.4); 96.4% were men. The most common genotype was type 1. The responses to treatment were generally poor, with only 48.4% of the patients achieving sustained virological response. DISCUSSION: Though the seroprevalence of chronic hepatitis C in the Latino veteran population of Puerto Rico is high, relatively few patients have received treatment, most probably because of the contraindications of the medications used. Combination therapy with pegylated interferon plus weight-based ribavirin was inefficient and plagued with side effects; as a whole, this therapy was not found to be overly beneficial to our patients. New emerging and approved therapies will change this paradigm, allowing the treatment of a larger population without the side effects of the studied therapy.

A Comparison of Brunt's Criteria, the Non-Alcoholic Fatty Liver Disease Activity Score (NAS), and a Proposed NAS Scoring that Includes Fibrosis in Non-Alcoholic Fatty Liver Disease Staging.

OBJECTIVE: The aim of this study was to determine the prevalence of NASH in veterans with metabolic syndrome and compare histologic grading using the Brunt criteria, the NAFLD activity score (NAS), and a proposed NAS scoring system that has been modified to include fibrosis staging. METHODS: Veterans with metabolic syndrome, hepatic steatosis, and elevated ALT and AST levels and who underwent liver biopsies from 2004 through 2010 were included in this study. Biopsies were evaluated by a single hepatopathologist. Each biopsy was analyzed using the Brunt criteria, the NAS system, and the NAS system plus fibrosis staging. RESULTS: Sixty patients having a mean age of 50.4 (±12.8 years) were included in the study; 88.3% were men. Fifty percent met criteria according to the Brunt system. When biopsies were classified using the NAS system, only 30.0% (18/60) were found to have a score of 5 or more, while, when adding fibrosis staging, the number of patients with a score of 5 or more increased to 33 (55.0%). Upon evaluating the predictive ability of the NAS scoring system, we found that when including fibrosis staging we obtained a higher sensitivity (86.7% vs. 40.0%) and a lower specificity (76.7% vs. 80.0%). CONCLUSION: In our population of patients with metabolic syndrome about 50 to 55% had steatohepatitis. There were significant differences between the scoring systems. When our NAS plus fibrosis system was used, more patients were recognized and the sensitivity increased. Further validation studies are required to evaluate this proposed modified NAS scoring system.