Pioglitazone for the Treatment of Metabolic-Associated Fatty Liver Disease in People Living With HIV and Prediabetes

Kamolvisit, Sarunporn; Chirnaksorn, Supphamat; Nimitphong, Hataikarn; Sungkanuparph, Somnuek

doi:10.7759/cureus.19046

Cited by 6 publications

(13 citation statements)

References 30 publications

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“…( 37 ) in the HDL analysis, Kamolvisit et al. ( 39 ) in the FBS analysis, and Cusi et al. ( 12 ) in HOMA-IR changes the substantiation of the corresponding results of the meta-analysis ( Supplementary Figure 5 ).…”

Section: Resultsmentioning

confidence: 61%

“…Due to the limitation of the number of studies, we included NASH and NAFLD for analysis. The involvement of both NAFLD ( 37 , 39 , 40 ) and NASH in the present study ( 11 , 12 , 36 , 38 ) also enhanced the heterogeneity of the research.…”

Section: Discussionmentioning

confidence: 60%

“…The limitations of the article are related to the research design and the biochemical and histological parameters. In terms of the research design, the doses of pioglitazone medication varied among studies (15 ( 37 ), 30 ( 36 , 38 – 40 ), and 45 mg/day ( 11 , 12 )), as well as the treatment courses (3 ( 37 ), 6 ( 11 , 40 ), 12 ( 36 , 39 ), 18 ( 12 ), and 24 months ( 38 )). Some studies implemented strict diet ( 11 , 12 , 36 , 37 , 39 ) and exercise ( 36 , 39 , 40 ) regimens, while some did not provide any information about lifestyle ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

“…In terms of the research design, the doses of pioglitazone medication varied among studies (15 ( 37 ), 30 ( 36 , 38 – 40 ), and 45 mg/day ( 11 , 12 )), as well as the treatment courses (3 ( 37 ), 6 ( 11 , 40 ), 12 ( 36 , 39 ), 18 ( 12 ), and 24 months ( 38 )). Some studies implemented strict diet ( 11 , 12 , 36 , 37 , 39 ) and exercise ( 36 , 39 , 40 ) regimens, while some did not provide any information about lifestyle ( 38 ). In addition, the inclusion criteria were also inconsistent among studies: some trials enrolled only type 2 diabetics ( 40 ), while others also included prediabetics.…”

Section: Discussionmentioning

confidence: 99%

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Response to pioglitazone in non-alcoholic fatty liver disease patients with vs. without type 2 diabetes: A meta-analysis of randomized controlled trials

Wang

Zhao

et al. 2023

Front. Endocrinol.

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BackgroundPioglitazone is considered a potential therapy for non-alcoholic fatty liver disease (NAFLD). However, different effects of pioglitazone on NAFLD have been demonstrated in diabetic and non-diabetic patients. Herein, a meta-analysis of randomized, placebo-controlled trials was carried out to indirectly compare pioglitazone in NAFLD patients with vs. without type 2 diabetes.MethodsRandomized controlled trials (RCTs) of pioglitazone vs. placebo involving NAFLD patients with or without type 2 diabetes/prediabetes collected from databases were enrolled into this analysis. Methodological quality was employed to evaluate the domains recommended by the Cochrane Collaboration. The analysis covered the changes in histology (fibrosis, hepatocellular ballooning, inflammation, steatosis), liver enzymes, blood lipids, fasting blood glucose (FBS), homeostasis model assessment-IR (HOMA-IR), weight and body mass index (BMI) before and after treatment, and adverse events.ResultsThe review covered seven articles, with 614 patients in total, of which three were non-diabetic RCTs. No difference was found in patients with vs. without type 2 diabetes in histology, liver enzymes, blood lipids, HOMA-IR, weight, BMI, and FBS. Moreover, no significant difference was revealed in adverse effects between NAFLD patients with diabetes and without DM, except the incidence of edema that was found to be higher in the pioglitazone group than in the placebo group in NAFLD patients with diabetes.ConclusionsPioglitazone could exert a certain effect on alleviating NAFLD, which was consistent between non-diabetic NAFLD patients and diabetic NAFLD patients in improving histopathology, liver enzymes, and HOMA-IR and reducing blood lipids. Furthermore, there were no adverse effects, except the incidence of edema which is higher in the pioglitazone group in NAFLD patients with diabetes. However, large sample sizes and well-designed RCTs are required to further confirm these conclusions.

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Section: Resultsmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Response to pioglitazone in non-alcoholic fatty liver disease patients with vs. without type 2 diabetes: A meta-analysis of randomized controlled trials

Wang

Zhao

et al. 2023

Front. Endocrinol.

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“…Hopefully, progress is being made in this regard. [32][33][34] A 2017 audit of United Kingdom HIV services found that 8.4% of PLWH had problematic alcohol use. 35 In contrast, we found a three-fold higher prevalence of hazardous alcohol use, which again in part may relate to the more assiduous evaluation of alcohol use in our study.…”

Section: Discussionmentioning

confidence: 99%

Nonviral Liver Disease Burden in People Living With HIV and Elevated Transaminases: A Cross-Sectional Study

Katarey,

Tan,

Mourad

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: Due to improved life expectancy in people living with HIV (PLWH), liver disease is increasingly being recognised. We assessed non-viral chronic liver disease (CLD) burden in PLWH. Methods: The HeAL (HIV non-virAL liver disease) study (2014-2021) prospectively recruited PLWH with elevated serum alanine aminotransferase (ALT) levels and negative hepatitis serology. Clinically significant hepatic fibrosis (CSHF) was defined as liver stiffness measurement (LSM) of >7.1 kPa and hazardous alcohol use as AUDIT score > 8. Primary outcome was prevalence/predictors of CSHF. Results: Total recruited were n=274, 92% male, median age 52 (45-59) years, 96% having undetectable HIV viral load. Overall, n=97 (35%) had hazardous alcohol use, n=72 (26%) had metabolic syndrome (MS) and 17%-27% had exposure to hepatotoxic antiretrovirals (ARV). Prevalence of CSHF was 20% (n=54), prevalence of cirrhosis (LSM >12.5 kPa) being 7% (19/274). Risk factors for CSHF were hazardous alcohol use in 44% (n=24), MS in 46% (n=25) and hepatotoxic ARV in 56% (n=30), majority having more than one risk factor. Independent predictors of CSHF were serum HDL (OR 0.220; 95% CI 0.061-0.790, p=0.020) (inverse relationship); serum AST (OR 1.033, 95% CI 1.001-1.067, p=0.045) and didanosine use (OR 2.878, 95% CI 1.228-6.774, p=0.015). Moderate-severe hepatic steatosis was identified in 52%(n=142). Both FIB-4 and APRI performed poorly in predicting CSHF (PPV 27.3% and 30.6% respectively) and advanced fibrosis(>F3) (PPV 17.6% and 5.9% respectively). Conclusion: In this study, 20% of PLWH had CSHF associated with high prevalence of hazardous alcohol use/MS/potentially hepatotoxic ARV. These potentially modifiable risk factors need addressing.

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Metabolic dysfunction-associated fatty liver disease in people living with HIV

Michel¹,

Labenz²,

Armandi

et al. 2023

Sci Rep

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The prevalence of metabolic risk factors and non-alcoholic fatty liver disease (NAFLD) is high among people living with HIV (PLWH). Data on the recently proposed definition of metabolic dysfunction-associated fatty liver disease (MAFLD) in PLWH receiving antiretroviral therapy (ART) remains unknown. A total of 282 PLWH were included in this cross-sectional cohort study. Vibration-controlled transient elastography (VCTE) was used to assess hepatic steatosis and fibrosis. MAFLD and its subgroups (overweight/obese, lean/normal weight, and type 2 diabetes) were defined according to a recently published international consensus statement. The majority of this cohort was male (n = 198, 70.2%), and the median age was 51.5 years. The median BMI was 25 kg/m2, and obesity was prevalent in 16.2% (n = 44). A total of 207 (73.4%) PLWH were classified as non-MAFLD while 75 (26.6%) qualified as MAFLD. The median CAP in the MAFLD group was 320 dB/m. PLWH with MAFLD showed a higher median LSM (p < 0.008) and were older (p < 0.005) compared to the non-MAFLD group. Overall, the metabolic risk profile was comparable between MAFLD and NAFLD. The majority of PLWH and MAFLD were overweight or obese (n = 58, 77.3%). The highest median LSM values were observed in the subgroup with MAFLD and type 2 diabetes. HIV-related parameters did not differ between non-MAFLD and MAFLD. The prevalence of MAFLD in PLWH is high and comparable to NAFLD. PLWH may be characterized according to the novel MAFLD criteria and its subgroups to identify patients at risk for chronic liver disease.

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Pioglitazone for the Treatment of Metabolic-Associated Fatty Liver Disease in People Living With HIV and Prediabetes

Cited by 6 publications

References 30 publications

Response to pioglitazone in non-alcoholic fatty liver disease patients with vs. without type 2 diabetes: A meta-analysis of randomized controlled trials

Response to pioglitazone in non-alcoholic fatty liver disease patients with vs. without type 2 diabetes: A meta-analysis of randomized controlled trials

Nonviral Liver Disease Burden in People Living With HIV and Elevated Transaminases: A Cross-Sectional Study

Metabolic dysfunction-associated fatty liver disease in people living with HIV

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