Firstly, serum insulin level was not detected and insulin resistance was previously shown to impair response to peginterferon plus ribavirin in CHC patients [25]. Secondly, we did not analyze HBV genotypes, where it is plausible that some genotypes exhibit ��steatoviruses�� characteristics, as shown in HCV genotype 3 [26]. Thirdly, we didn’t use liver biopsy in determining hepatic steatosis, as Nintedanib purchase this test is invasive and may cause both minor and major complications [27]. In this study, as elevated HBV-DNA and ALT levels were found in all CHB patients, there might be of less value to preclude other causes of liver damage by biopsy. In contrast, the non-invasive hepatic ultrasound showed a sensitivity over 80% and specificity over 90% for steaosis [28].
Therefore, hepatic ultrasound was used to detect steatosis in daily clinical practice for the strength of the least expensive and most convenient modality [29], as was done in our study. Fourthly, we only analyzed Chinese patients and our results need verification in other ethnics. Finally, we have not observed any resistance to Entecavir until the end of this study, which may be due to the relatively short observation period and low amount of subjects. Nevertheless, those weaknesses could not overwhelm the original findings of this prospective unmatched nested case control study, which may change the standard therapy of CHB patients with NAFLD. In summary, this study demonstrated, for the first time, that hepatic steatosis is significantly associated with Entecavir treatment failure in CHB patients.
Current study also confirmed the association of metabolic factors with hepatic steatosis. These novel results raised the issue on developing specific treatment strategy in CHB patients with NAFLD, which needs investigation in the future. Further studies should also focus on the molecular mechanism of steatosis on nonresponse to Entecavir and other antiviral drugs. Supporting Information Table S1 Univariate analysis of factors associated with nonresponse to Entecavir at 24 week. (DOC) Click here for additional data file.(28K, doc) Table S2 Univariate analysis of factors associated with nonresponse to Entecavir at 48 week. (DOC) Click here for additional data file.(29K, doc) Table S3 Univariate analysis of factors associated with nonresponse to Entecavir at 96 week. (DOC) Click here for additional data file.
(28K, doc) Footnotes Competing Interests: The authors have declared that no competing interests exist. Funding: This study is sponsored by the 2010 National Natural Science Foundation of China (Project 81000169), 2010 Excellent Young Investigator Foundation of Health AV-951 Bureau of Zhejiang Province (Project 2010QNA011) and 2011 Excellent Young Investigator Natural Science Foundation of Zhejiang province (Project R2110159). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.