Hepatic steatosis in patients coinfected with human immunodeficiency virus/hepatitis C virus: A meta-analysis of the risk factors

Abstract

Hepatic steatosis (HS) is frequent in patients with hepatitis C virus (HCV) infection, occurring in 40%-80%, associating with metabolic and virus-related factors, namely, genotype 3 and viral load. Human immunodeficiency virus (HIV) infection and antiretroviral treatment seem to be risk factors for HS. Several studies addressed this issue in coinfected patients, with discrepant results. A meta-analysis was performed on the HS risk factors in coinfected patients. Eligible studies were identified through structured keywords including coinfection, HCV, HIV, and steatosis in relevant databases including PubMed. Pooled odds ratios (ORs) and confidence limits (CIs) were obtained with the random-effects model and the DerSimonian-Laird method. Twelve studies, including 1,989 coinfected patients, were selected. Twenty percent were infected with HCV genotype 3. The overall prevalence of HS was 50.8% (23%-72%). Four studies also included 1,540 HCV monoinfected patients, not showing an increased risk for HS in coinfected patients (OR 1.61, 95% CI 0.84-3.10, P 5 0.151). In coinfected patients, HS was associated with higher body mass index (OR 1.13, 95% CI 1.07-1.19, P < 0.001), diabetes mellitus (OR 2.32, 95% CI 1.32-4.07, P 5 0.003), elevated alanine aminotransferase levels (OR 1.28, 95% CI 1.02-1.61, P 5 0.035), necroinflammatory activity (OR 1.72, 95% CI 1.11-2.67, P 5 0.016), and fibrosis (OR 1.67, 95% CI 1.20-2.34, P 5 0.003). No associations were found between HS and gender, other metabolic factors (dyslipidemia, glucose, metabolic syndrome), HCV-related factors (genotype, viral load), or HIV-related factors (viral load, CD4 count, antiretroviral therapy, and class of medication). Conclusion: In coinfected patients, HS does not seem to be more frequent than in HCV monoinfected patients and is mostly associated with metabolic factors, such as increased weight, diabetes mellitus, and more severe liver disease. The fact that no associations with HCV factors were found may be due to the small percentage of genotype 3-infected patients. (HEPATOLOGY 2010;52:71-78)

Influence of antiretroviral therapy on liver disease

“…Hepatic steatosis is associated with the presence of significant fibrosis and hepatic necro-inflammatory activity [17,23,47,48,49 ] and thus may contribute to the more rapid progression of liver disease in coinfected patients. Several studies sought to investigate the role of ART in the pathogenesis of hepatic steatosis in HIC/ HCV-coinfected populations.…”

Associated Factors and Liver Disease Severity for Decreased Bone Mineral Density in HIV Mono- and HIV/HCV Co-infected Patients

“…Hepatitis C virus (HCV) infection is a major health problem in the HIV-infected population [13]. A recent systematic review and meta-analysis suggests that HIV/HCV co-infection is associated with a greater risk of osteoporosis than HIV mono-infection [14], although many divergences exist regarding osteoporosis prevalence in co-infected patients, with values ranging from 5-45%.…”

S2k-Leitlinie nicht alkoholische Fettlebererkrankungen

“…Grundsätzlich sollte bei Patienten mit HIV und NAFLD, insbesondere bei Medikamentenumstellung, die Kontrolle der Leberwerte erfolgen. (starker Konsens, Empfehlung)Kommentar HIV-Infektion und die Therapie mit antiretroviralen Medikamenten insbesondere NRTI werden gemeinhin als Risikofaktor für die NAFLD angesehen[545]. Metabolische Veränderungen, die allgemein mit einer Fettleber assoziiert sind, sind bei HIVinfizierten Patienten häufig anzutreffen.…”

“…Die klinische Evidenz insbesondere aus neueren Studien ist für diese Einschätzung jedoch gering. Bisher ist nur eine Metanalyse zum Thema "HIV und Fettleber" und zwar in der Kohorte HCV-HIV-Koinfizierter publiziert worden[545]. In dieser Metaanalyse wurden 12 Studien mit insgesamt 1989 HIV/HCV koinfizierten und 1540 HCV monoinfizierten Patienten analysiert.…”