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.