Background and study aim: Hepatic steatosis in hepatitis C virus (HCV) infected patients has been shown to enhance the progression of liver fibrosis and decrease the response to antiviral therapy. The current study is designed to investigate the impact of hepatic steatosis on the outcome of pegylated interferon and ribavirin combination therapy in patients with chronic hepatitis C genotype 4.
 
Patients and Methods: A total number of 200 patients were selected from 270 patients who were referred to HCV Treatment Unit of New Mansoura General Hospital from February 2012 to August 2013 after taking an informed consent. They were 129 males and 71 females, their ages ranged from 25 to 55 years (mean value, 35.5±15.2). They had proven chronic hepatitis C virus based on history of exposure, clinical manifestations, positive anti-HCV antibody, positive HCV viremia, and liver biopsy findings suggestive of chronic hepatitis C.
Results: Group I: included 100 patients (70 men and 30 women; mean age of 42.9±12 years) without liver steatosis. Group II: included 100 patients (59 men and 41 women; mean age of 45.23±11 years) with liver steatosis. In terms of steatosis grading using the NAS and METAVIR scoring systems, 50% had no staetosis while 8.5% had mild staetosis, 18.5% had moderate steatosis and 23% had severe steatosis. Body mass index of patients receiving interferon is significant between both groups. Hepatomegaly shows significant values between both groups. Platelets count, ALT, AST, S.Cholesterol & S.Triglycerides levels has statistically significant differences between group I (non steatotic) and group II (steatotic). There is statistically significant difference between both groups on necro-inflamatory activity grades. High statistical significance difference between grading of steatosis and Necro-inflammation. Statistical significance difference between grading of steatosis and fibrosis stages. Statistical significance difference between both groups at SVR and Steatosis has a negative effect on SVR by comparison to non steatotic group. High degree of hepatic steatosis has a negative impact on pagylated interferon and ribavirin therapy in chronic HCV genotype 4 minimizing sustained virologic response rates.
Conclusion: Our study confirms that hepatic steatosis correlates with BMI, S.cholesterol, S.triglycerides, fibrosis,  necro-inflammatory stages and has a negative impact on response to antiviral therapy.