Histological Findings and Clinical Characteristics Associated with Hepatic Steatosis in Patients Coinfected with HIV and Hepatitis C Virus

Marks, Kristen; Petrovic, Lydia M.; Talal, Andrew H.; Murray, Melissa P.; Gulick, Roy M.; Glesby, Marshall J.

doi:10.1086/497608

Cited by 71 publications

(106 citation statements)

References 42 publications

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“…There was no association between gender and the prevalence of HS in HIV/HCV-coinfected patients, either in individual studies or in the pooled data: pooled OR for female sex was 0.85, 95% CI 0.60-1.21, P ¼ 0.365, in 10 studies. [19][20][21][22]24,26,27,29,30 Similarly, HS prevalence was not different in African-American patients: pooled OR was 0.76, 95% CI 0.24-2.48, P ¼ 0.668, in two studies. 21,24 As verified in seven studies, [19][20][21][22]24,29,30 alcohol consumption was not associated with an increased risk of HS (pooled OR 0.95, 95% CI 0.70-1.30, P ¼ 0.761).…”

Section: Resultsmentioning

confidence: 86%

“…Twelve studies were included [19][20][21][22][23][24][25][26][27][28][29][30] addressing a total of 1,989 HIV/HCV-coinfected patients. In four of these studies 20,24,25,28 data regarding HCV-monoinfected patients were presented separately, with a total of 1,540 patients.…”

Section: Resultsmentioning

confidence: 99%

“…In four of these studies 20,24,25,28 data regarding HCV-monoinfected patients were presented separately, with a total of 1,540 patients. Three studies had a retrospective recruitment 21,22,25 ; the remaining were prospective. HS was always evaluated by liver biopsy.…”

Section: Resultsmentioning

confidence: 99%

“…33 Two studies 25,26 used the chronic hepatitis C validated METAVIR classification system, 34 in which steatosis is considered mild if present in 1%-10% of the hepatocytes, moderate in 11%-30%, and severe when in more than 30%. Necroinflammation and fibrosis were graded or staged by METAVIR 20,21,23,25,26 or Ishak classifications. 35 Steatosis Prevalence.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the presence of DM, seven studies [20][21][22]24,27,29,30 analyzed a possible association with increased risk for HS, although only two showed a significant association. 24,30 However, in the pooled data analysis there was a strong statistically significant association (pooled OR 2.32, 95% CI 1.32-4.07, P ¼ 0.003) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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

2010

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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)

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

2010

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Hepatobiliary Manifestations of Human Immunodeficiency Virus

Vachon

Perumalswami

Dieterich

2011

Schiff's Diseases of the Liver

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Steatohepatitis: Risk factors and impact on disease severity in human immunodeficiency virus/hepatitis C virus coinfection

et al. 2008

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Hepatic steatosis has been reported in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection. However, the features of steatohepatitis, including cytologic ballooning and pericellular fibrosis, its risk factors, and the impact on disease severity in such patients are unknown. To assess this, we prospectively reviewed liver histology in consecutive coinfected patients to define the prevalence and severity of the features of steatohepatitis, its risk factors, and its impact on the severity of liver disease. A total of 222 subjects (74% male, mean age 45, 78% African American, 90% genotype 1) were studied. The mean body mass index (BMI) was 26, and 18% had a BMI >30. The prevalence of risk factors for steatosis were: diabetes (31%), hypertension (15%), dyslipidemia (8%), metabolic syndrome (9%), and alcohol abuse (21%). Steatosis was present in 23% and steatohepatitis was present in 17%. The steatosis was mild (5%-33%) in 19%, and moderate to severe (>33%) in 4%. Cytologic ballooning and pericellular fibrosis were present in 30% and 13%, respectively. The mean Ishak score was 6.9, and 33% had bridging fibrosis or cirrhosis. Both steatosis and cytologic ballooning were associated with BMI, metabolic syndrome, and insulin resistance, and presence of either was strongly associated with advanced fibrosis (P < 0.0001). By multiple logistic regressions, the following associations were identified: increased BMI, diabetes, and genotype 3 with steatosis; diabetes with cytologic ballooning; and longer duration of infection with steatohepatitis. Conclusion: Steatosis and steatohepatitis are present in 23% and 30%, respectively, of patients with HIV/HCV coinfection, and both are associated with an increased risk of having advanced fibrosis. Although we did identify genotype 3, increased BMI, and diabetes as risk factors, we found no independent association with antiretroviral therapy.

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Histological Findings and Clinical Characteristics Associated with Hepatic Steatosis in Patients Coinfected with HIV and Hepatitis C Virus

Cited by 71 publications

References 42 publications

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

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

Hepatobiliary Manifestations of Human Immunodeficiency Virus

Steatohepatitis: Risk factors and impact on disease severity in human immunodeficiency virus/hepatitis C virus coinfection

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