Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: A meta-analysis of individual patient data

Background & Aims: Steatosis is a frequent histologic finding in chronic hepatitis C (CHC), but it is unclear whether steatosis is an independent predictor for liver fibrosis. We evaluated the association between steatosis and fibrosis and their common correlates in persons with CHC and in subgroup analyses according to hepatitis C virus (HCV) genotype and body mass index. Methods: We conducted a meta-analysis on individual data from 3068 patients with histologically confirmed CHC recruited from 10 clinical centers in Italy, Switzerland, France, Australia, and the United States. Results: Steatosis was present in 1561 patients (50.9%) and fibrosis in 2688 (87.6%). HCV genotype was 1 in :1694 cases (55.2%), 2 in 563 (18.4%), 3 in 669 (21.8%), and 4 in :142 (4.6%). By stepwise logistic regression, steatosis was associated independently with genotype 3, the presence of fibrosis, diabetes, hepatic inflammation, ongoing alcohol abuse, higher body mass index, and older age. Fibrosis was associated independently with inflammatory activity, steatosis, male sex, and older age, whereas HCV genotype 2 was associated with reduced fibrosis. In the subgroup analyses, the association between steatosis and fibrosis invariably was dependent on a simultaneous association between steatosis and hepatic inflammation. Conclusions: In this large and geographically different group of CHC patients, steatosis is confirmed as significantly and independently associated with fibrosis in CHC. Hepatic inflammation may mediate fibrogenesis in patients with liver steatosis. Control of metabolic factors (such as overweight, via lifestyle adjustments) appears important in the management of CHC.

Australia's relationship with the United States: The case for greater independence

A number of recent events-especially attempts to negotiate a bilateral trade agreement and Australia's participation in the conflicts in Afghanistan and Iraq(1)-have thrown Australia's relationship with the United States into sharp relief. While this relationship has historically enjoyed strong bilateral endorsement, such uncritical support is beginning to unravel. At the very least, the relationship is being subjected to a renewed, more critical scrutiny. This paper argues that a dispassionate analysis of the relationship is appropriate and overdue. Not only are the benefits that accrue to 'Australia' from the relationship debateable, even when judged within the limited calculus of the 'national interest', but Australia's uncritical support for US foreign policy is also helping to entrench potentially damaging aspects of American foreign policy and somewhat ironically-undermining the legitimacy of its pre-eminent 'hegemonic' position.

Diplomatic divergence in the antipodes: Globalisation, foreign policy and state identity in Australia and New Zealand

This article compares the constitutive relationship between foreign policy and globalisation in Australia and New Zealand. Drawing upon insights from constructivist international relations theory we argue that foreign policy instantiates a state's social identity, its self-understanding of its role and moral purpose by projecting a distinctive image onto the global stage. We explore the differences and the similarities between Australia and New Zealand by examining how each country views international order, global trade, global governance and human rights and international security. Although both countries appear to be transforming themselves into more 'globalised' states, there are significant differences in the way each seeks to balance the competing strategic and normative demands. This diplomatic divergence, we argue, stems from different conceptions of state identity.