Adipose Tissue and Metabolic Factors Associated With Steatosis in HIV/HCV Coinfection: Histology Versus Magnetic Resonance Spectroscopy

Ghotb, Alireza; Noworolski, Susan M.; Madden, Erin; Scherzer, Rebecca; Qayyum, Aliya; Pannell, Jane; Ferrell, Linda D.; Peters, Marion G.; Tien, Phyllis C.

doi:10.1097/qai.0b013e3181e1d963

Cited by 10 publications

(10 citation statements)

References 16 publications

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“…We also considered whether the accuracy of MRS‐measured HS may be altered by HCV‐related fibrosis or inflammation. We demonstrated previously that MRS and histologic steatosis were strongly associated in 42 HIV/HCV‐coinfected men and women, including 20 women who also participated in our current study . Others have shown that HCV, hepatic inflammation, and fibrosis do not directly influence the accuracy of MRS in detecting HS .…”

Section: Discussionmentioning

confidence: 49%

“…We demonstrated previously that MRS and histologic steatosis were strongly associated in 42 HIV/HCVcoinfected men and women, including 20 women who also participated in our current study. (44) Others have shown that HCV, hepatic inflammation, and fibrosis do not directly influence the accuracy of MRS in detecting HS. (35,45) However, some have suggested that as fibrosis progresses and hepatocytes are replaced by fibrous tissue, MRS may underestimate the percentage of steatotic hepatocytes.…”

Section: Discussionmentioning

confidence: 99%

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Human immunodeficiency virus–infected and uninfected adults with non–genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection

Price

Scherzer

et al. 2017

Hepatology

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Background Hepatic steatosis (HS) is common in persons with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, but the independent contributions of HCV and HIV to HS is unclear. Methods Magnetic resonance imaging and spectroscopy were used to measure visceral adipose tissue (VAT) and liver fat fraction (LFF) [total lipids/(total lipids+water)] in 356 adults: 57 HCV-monoinfected, 70 HIV/HCV-coinfected, 122 HIV-monoinfected, and 107 HIV/HCV-uninfected. Genotype 3 HCV-infected participants were excluded due to the genotype's reported steatogenic effects. For prevalence estimates, HS was defined as LFF≥0.05. We estimated the association of HIV and HCV status with LFF using multivariable linear regression, adjusting for demographic, lifestyle, and metabolic factors including the homeostasis model assessment estimate of insulin resistance (HOMA-IR) and liver fibrosis defined using the AST-to-platelet ratio index (APRI). Results The prevalence of HS was highest in the uninfected(33%) and HIV-monoinfected(28%), followed by the HCV-monoinfected(19%) and HIV/HCV-coinfected(11%)(p=0.003 across groups). Compared to uninfected participants, after adjusting for demographic, lifestyle, and metabolic factors, HIV monoinfection, HCV monoinfection and HIV/HCV coinfection were associated with 19%(95%CI:-39%,6%), 38%(95%CI:-55%,-12%) and 42%(95%CI:-59%,-18%) lower LFF, respectively. HCV monoinfection and HIV/HCV coinfection remained strongly associated with lower LFF after further adjusting for APRI, and results were unchanged after excluding subjects with suspected cirrhosis. Among the entire cohort, Hispanic ethnicity, male sex, VAT, and HOMA-IR were independently associated with greater LFF. Conclusions Contrary to expectations, HIV/HCV-coinfected and HCV-monoinfected adults had significantly less liver fat than uninfected adults, even after adjusting for demographic, lifestyle, metabolic factors, and hepatic fibrosis. Our findings suggest that non-genotype 3 HCV infection may be protective against HS. The mechanisms by which this occurs and impact of HCV treatment on HS need investigation.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Human immunodeficiency virus–infected and uninfected adults with non–genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection

Price

Scherzer

et al. 2017

Hepatology

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“…NAFLD can progress to cirrhosis and its complications, including hepatocellular carcinoma in up to 20% of patients[10]. Steatosis is also reported in 14 to 54% of HIV-monoinfected adults in the modern era of ART[2–4, 11–15]. HIV-infected adults may be at particular risk because HIV-related perturbations in adipose tissue and insulin resistance are common[3, 4, 16].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in the association of HIV infection with hepatic steatosis

Kardashian

Ma²,

Scherzer³

et al. 2017

Aids

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Background Hepatic steatosis is increasing worldwide. Whether HIV and its associated metabolic perturbations exacerbate steatosis is unclear. Sex differences in adipose tissue distribution may also affect steatosis risk. We examined the contribution of HIV and sex to steatosis. Methods Using magnetic resonance imaging and spectroscopy, visceral adipose tissue (VAT) and liver fat fraction (LFF) were measured in 121 HIV-infected and 107 uninfected men and women without viral hepatitis. Differences in LFF by HIV status and sex were evaluated using multivariable linear regression, adjusting for demographic, lifestyle, VAT, homeostasis model assessment-estimated insulin resistance (HOMA-IR), and HIV-related factors. Results HIV-infected women had lower LFF than uninfected women (demographic-adjusted mean:1.9% vs. 3.1%;p=0.028); LFF was similar in HIV-infected and uninfected men (4.6% vs. 4.1%;p=0.78). HIV-infected and uninfected women had less VAT than men (median:139cm3 and 161cm3 vs 201cm3 and 188cm3, respectively). After adjustment, HIV-infected women had 34%(95%CI:−54%,−5.5%) lower LFF than uninfected women, whereas there was little difference in men (−5.5%;95%CI:−26%,21%). Among HIV-infected persons, greater VAT and HOMA-IR were associated with greater LFF. HIV-related factors (CD4 count, HIVRNA level, or antiretroviral therapy use) had little association with LFF. Although HIV-infected men had 81%(95%CI:32%,148%) greater LFF than HIV-infected women, the association was attenuated after multivariable adjustment (25%;95%CI:−9.1%,73%). Conclusion Contrary to expectation, HIV infection is not associated with greater steatosis compared to uninfected adults. It is possible that less fat is stored in the liver to maintain subcutaneous fat (which is reduced in HIV) and the effect is magnified in HIV-infected women, who also have less VAT.

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“…In many previous studies spectroscopy data were obtained under free breathing [5, 7, 8], which can introduce motion artifact related to respiratory movement and thereby affect the quality of spectral data. Technical improvements have allowed the use of breath-hold sequences and therefore shorter acquisition times for patients.…”

Section: Discussionmentioning

confidence: 99%

Hydrogen-1 MR Spectroscopy for Measurement and Diagnosis of Hepatic Steatosis

Georgoff

Thomasson

Louie

et al. 2012

American Journal of Roentgenology

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OBJECTIVE Hydrogen-1 MR spectroscopy (1H-MRS) is gaining acceptance as a noninvasive technique for assessment of hepatic steatosis, and the findings have been found to correlate closely with histopathologic grade. The aims of this study were to validate 1H-MRS performed with a 3-T MRI system for quantifying hepatic steatosis and to determine threshold values of 1H-MRS proton density fat fraction corresponding to standard histopathologic grade in patients undergoing diagnostic liver biopsy. SUBJECTS AND METHODS We conducted a prospective cross-sectional liver MRS study with 52 subjects undergoing diagnostic liver biopsy. The diagnostic accuracy of 1HMRS was evaluated with receiver operating characteristic curves. RESULTS The diagnostic accuracy of 1H-MRS for hepatic steatosis was high with an area under the receiver operating characteristic curve of 0.94 (95% CI, 0.88–1.0). Results were similar for three 1H-MRS measurements obtained at different locations in the liver, for two independent pathologists, and whether fibrosis was present or absent. One third of participants had elevated transaminase concentrations of unknown cause, and 1H-MRS estimates of steatosis had perfect agreement with histopathologic grade in this group. Calculated 1H-MRS proton density fat fraction thresholds for histologic grades were less than 17% for grade 0 or trace steatosis, 17–38.6% for grade 1, and greater than 38.6% for grade 2 or higher. CONCLUSION Hydrogen-1 MR spectroscopy is an effective, noninvasive technique that can be used to diagnose and quantify hepatic steatosis. Hydrogen-1 MR spectroscopy thresholds corresponded with histopathologic grades and may be useful in the workup of patients with elevated transaminase concentrations.

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Adipose Tissue and Metabolic Factors Associated With Steatosis in HIV/HCV Coinfection: Histology Versus Magnetic Resonance Spectroscopy

Cited by 10 publications

References 16 publications

Human immunodeficiency virus–infected and uninfected adults with non–genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection

Human immunodeficiency virus–infected and uninfected adults with non–genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection

Sex differences in the association of HIV infection with hepatic steatosis

Hydrogen-1 MR Spectroscopy for Measurement and Diagnosis of Hepatic Steatosis

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