Hepatic Steatosis in Human Immunodeficiency Virus

Abstract

Background and Aims Abnormal liver enzymes (LE) are common in those infected with HIV. Histologic data on those with abnormal LE without viral hepatitis are lacking. Methods HIV positive subjects without HCV, HBV, alcohol abuse, and DM with more than 1 abnormal LE, defined as 1.25 ULN in AST, ALT, or ALP, over 6 months were included. Subjects underwent a 2 hr oral glucose tolerance test, fasting lipids, insulin and glucose for insulin resistance (IR) by HOMA-IR and DEXA for fat distribution. Biopsies were read blindly to clinical data, and scored by Ishak histologic activity index (HAI) for inflammation and fibrosis and NAFLD Activity Score (NAS). Results Fourteen patients underwent biopsy. All were on highly active anti-retroviral therapy (HAART) with undetectable HIV RNA and mean CD4 614. The HAI scores for inflammation and fibrosis were 3.43(1.4) and 1.71(1.26), respectively, and 2 patients had advanced fibrosis (bridging fibrosis/cirrhosis). The majority (65%) of patients had steatosis: grade 1:21%, grade 2:28%, and grade 3:14%. Hepatocyte ballooning was seen in 7 (40%) but NASH was diagnosed only in 4(26%). NAS score of all biopsies of 3.07(2.2; range 0–5). Insulin resistance (HOMA-IR) was higher in those with compared to those without steatosis (3.52 vs. 1.91; p=.11) and highest in those with NASH (4.89). Using multivariate logistic regression, only increased GGT (p=.0009) predicted steatosis while HOMA-IR (p=.0046) predicted NASH. Conclusions Although steatosis is common in HIV patients with abnormal LE without DM, alcohol, or viral hepatitis coinfection, NASH was observed in only 26%. The only clinical or laboratory feature associated with biopsy proven steatosis and NASH were GGT and a calculated measure of insulin resistance, respectively. Further studies are needed in this population to determine the long term clinical significance.

Validation of Noninvasive Methods for Detecting Hepatic Steatosis in Patients With Human Immunodeficiency Virus Infection

“…The study populations included HIV+ patients who either had steatosis or were coinfected with HCV. The first cohort consisted of HIV+ patients without HCV with at least 5% steatosis on a liver biopsy (12). The second cohort consisted of HIV-HCV patients.…”

The Prevalence and Impact of Hepatic Steatosis on Response to Direct-Acting Antiviral Therapy in HIV–HCV Coinfection

“…The prevalence of hepatic steatosis is common in those with HIV, including those with HIV-HCV coinfection [1][2][3][4][5], and may be due to the high prevalence of the metabolic syndrome in those with HIV [43]. The prevalence of steatosis in the present cohort (27%) is at the lower end of the spectrum compared to past reports on HIV-HCV coinfection (23-75%) [1] and is related to BMI, obesity, and dyslipidemia, but not to diabetes and hypertension-two components of the metabolic syndrome.…”

“…Hepatic steatosis is common in patients living with human immunodeficiency virus (HIV), including those coinfected with chronic hepatitis C virus (HCV) [1,2]. In studies of HIV patients at risk for steatosis (e.g., increased liver enzymes) without HCV using liver histology as reference standard, steatosis was detected in 60%-69% [2][3][4][5] compared to 23%-75% of those with HIV-HCV coinfection [1] and 40%-86% of those with chronic HCV without HIV [6].…”

“…Hepatic steatosis is common in patients living with human immunodeficiency virus (HIV), including those coinfected with chronic hepatitis C virus (HCV) [1,2]. In studies of HIV patients at risk for steatosis (e.g., increased liver enzymes) without HCV using liver histology as reference standard, steatosis was detected in 60%-69% [2][3][4][5] compared to 23%-75% of those with HIV-HCV coinfection [1] and 40%-86% of those with chronic HCV without HIV [6]. Similar to those without HIV, the development of steatosis in patients with HIV is often secondary to the presence of the metabolic syndrome and its components (diabetes, obesity, hypertension, and dyslipidemia), HIV-related lipodystrophy, microbial dysbiosis and mitochondrial damage leading to insulin resistance and dyslipidemia [7][8][9].…”

Managing dyslipidemia in HIV/AIDS patients: challenges and solutions

“… 42 Sterling et al showed that NAFLD is around 26%, and the only clinical or laboratory feature associated with biopsy-proven steatosis was γ-glutamyl transpeptidase and insulin resistance. 43 NAFLD is also seen in HIV patients who are coinfected with hepatitis C. 44 , 45 The only effective therapy for NAFLD is weight loss, and the use of statins with NAFLD appears to be safe and effective.…”