El Tawil AI, Ivantes CAP. Letter to the Editor: Steatotic liver disease in chronic hepatitis C - a marker of systemic risk, not direct-acting antiviral treatment failure. World J Hepatol 2026; 18(6): 117018 [DOI: 10.4254/wjh.117018]
Corresponding Author of This Article
Abdo Imad El Tawil, Principal Investigator, Researcher, Department of Medical Research, Faculdade Evangélica Mackenzie do Paraná, Rua Padre Anchieta 2770, Curitiba 80730-000, Paraná, Brazil. abdoieltawil@gmail.com
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Gastroenterology & Hepatology
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letter
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El Tawil AI, Ivantes CAP. Letter to the Editor: Steatotic liver disease in chronic hepatitis C - a marker of systemic risk, not direct-acting antiviral treatment failure. World J Hepatol 2026; 18(6): 117018 [DOI: 10.4254/wjh.117018]
World J Hepatol. Jun 27, 2026; 18(6): 117018 Published online Jun 27, 2026. doi: 10.4254/wjh.117018
Letter to the Editor: Steatotic liver disease in chronic hepatitis C - a marker of systemic risk, not direct-acting antiviral treatment failure
Claudia Alexandra Pontes Ivantes, Abdo Imad El Tawil
Abdo Imad El Tawil, Department of Medical Research, Faculdade Evangélica Mackenzie do Paraná, Curitiba 80730-000, Paraná, Brazil
Claudia Alexandra Pontes Ivantes, Department of Internal Medicine, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba 80810-070, Paraná, Brazil
Author contributions: El Tawil AI wrote the original draft; Ivantes CAP contributed to the conceptualization, writing, reviewing, and editing; El Tawil AI and Ivantes CAP participated in drafting the manuscript; all authors have read and approved the final version of the manuscript.
AI contribution statement: OpenEvidence was the AI tool used for literature search and identification of relevant scientific references, mainly by addressing important recent updates on the theme we comment on in our work. ChatGPT was used for language polishing, stylistic refinement, and improvement of textual clarity. Paperpal was the AI tool used for professional grammar assessment, as being a recognized program for this activity. Additionally, no AI tools were used to generate scientific hypotheses, study design, data interpretation, or the scientific conclusions of this manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Abdo Imad El Tawil, Principal Investigator, Researcher, Department of Medical Research, Faculdade Evangélica Mackenzie do Paraná, Rua Padre Anchieta 2770, Curitiba 80730-000, Paraná, Brazil. abdoieltawil@gmail.com
Received: December 8, 2025 Revised: February 8, 2026 Accepted: March 31, 2026 Published online: June 27, 2026 Processing time: 193 Days and 13.8 Hours
Abstract
The study by Janczura et al, published in the recent issue of the World Journal of Hepatology, present real-world evidence on the clinical interplay between steatotic liver disease (SLD) and chronic hepatitis C in the era of direct-acting antivirals. Their findings revealed that SLD affects more than 40% of treated patients, characterizing a population marked by significant metabolic vulnerability, recurrently with older age, elevated body mass index, diabetes, and dyslipidemia. This positions SLD as a broader marker of systemic risk rather than an isolated hepatic condition. The strong association between SLD and genotype 3 further reinforces the lipotropic profile of this genotype. Although patients with SLD presented with more advanced fibrosis and experienced slightly lower sustained virologic response rates, the study clearly showed that SLD itself is not an independent predictor of direct-acting antivirals treatment failure. In contrast, cirrhosis and genotype 3 infections remain the main determinants of treatment failure. The high frequency of complications and mortality among individuals with SLD underscores the need for integrated metabolic, hepatic, and behavioral management, including alcohol risk mitigation. These insights highlight the importance of addressing SLD as a combined feature in chronic hepatitis C management, as it guides prognosis and the requirement for long-term metabolic monitoring, thereby optimizing outcomes in this population.
Core Tip: This letter discusses the real-world findings of Janczura et al, who evaluated the impact of steatotic liver disease on chronic hepatitis C virus infection in the era of direct-acting antivirals. Their work highlights how metabolic dysfunction, aging, and genotype-specific characteristics contribute to persistent liver risk despite viral cure. By emphasizing the role of noninvasive steatosis assessment in identifying high-risk patients and guiding long-term monitoring, this correspondence reinforces the clinical relevance of steatotic liver disease in shaping the prognosis and follow-up strategies for individuals with current or past hepatitis C virus infection.
