Prevalence of and Factors Associated With Hepatic Steatosis in Patients Coinfected With Hepatitis C Virus and HIV

Néau, Didier; Winnock, María; Castéra, Laurent; Bail, Brigitte Le; Loko, Marc-Arthur; Geraut, Laurent; Dupon, M.; Ragnaud, Jean‐Marie; Lacoste, D.; Lafon, Marie‐Edith; Bioulac‐Sage, Paulette; Dabis, François

doi:10.1097/qai.0b013e318042e1db

Cited by 25 publications

(23 citation statements)

References 36 publications

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“…This finding correlates with the results of many cross-sectional studies which show that a higher BMI is associated with the presence as well as severity of steatosis 6,7,9,12,14,29. While much of the study population had normal BMI, 48% of individuals were either overweight or obese.…”

Section: Discussionsupporting

confidence: 89%

“…This finding is markedly lower than estimates obtained from prior cross-sectional studies, which range from 23%–32% 6,7,11,12. The likely explanation for this difference is the composition of our study population as well as the modification of the specific type of antiretroviral drugs used over time with markedly diminished prescription of agents, such as stavudine and didanosine which have been linked with impairment of mitochondrial DNA replication.…”

Section: Discussioncontrasting

confidence: 73%

“…The likely explanation for this difference is the composition of our study population as well as the modification of the specific type of antiretroviral drugs used over time with markedly diminished prescription of agents, such as stavudine and didanosine which have been linked with impairment of mitochondrial DNA replication. Further, while prior studies have shown that Caucasian race and HCV genotype 3 are associated with steatosis6,7,10,12,14,15, African-Americans comprised 87% of patients in our study and 94% were infected with HCV genotype 1. The strong associations between steatosis and HCV genotype, race, and other factors underscore the importance of carefully measuring these covariates in related research studies.…”

Section: Discussioncontrasting

confidence: 48%

“…The etiology of steatosis in co-infected patients is multifactorial, related to both host and viral factors, similar to those observed in HCV-monoinfected patients 16,17. Studies have identified Caucasian race, obesity, hyperglycemia, hyperlipidemia, lipodystrophy, and HCV viral load as risk factors for steatosis6,7,9,10,12–15, but these data derive primarily from cross-sectional studies. Further, in patients infected with HCV genotype 3, the virus is thought to cause steatosis through a direct cytopathic effect 18…”

Section: Introductionmentioning

confidence: 96%

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Incidence and Risk Factors for Steatosis Progression in Adults Coinfected With HIV and Hepatitis C Virus

et al. 2011

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 73%

Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 96%

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Incidence and Risk Factors for Steatosis Progression in Adults Coinfected With HIV and Hepatitis C Virus

et al. 2011

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“…Most histology data on steatosis in subjects with HIV have been limited to patients coinfected with HCV and found a high proportion (40–75%) with steatosis (25–33) that is greater than expected from the general population. Several independent factors have been associated with steatosis in coinfected patients including Caucasian race (25), increased body mass index (25, 27–30), glucose intolerance (25; 29), use of DDII or D4T (25; 31), increased lipids (32; 33), and HCV genotype 3 (27–31; 33). However, a recent meta-analysis comparison found no significant difference (OR 1.61; 95% CI 0.84–3.10) in steatosis between coinfected patients (n=489) compared to those with HCV alone (n=1540) (34).…”

Section: Discussionmentioning

confidence: 99%

Hepatic Steatosis in Human Immunodeficiency Virus

Sterling

Smith²,

Brunt

2013

Journal of Clinical Gastroenterology

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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.

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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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Prevalence of and Factors Associated With Hepatic Steatosis in Patients Coinfected With Hepatitis C Virus and HIV

Abstract: Liver inflammation, HCV genotype 3, and BMI are associated with steatosis, a common finding in HCV-HIV-coinfected patients.

Cited by 25 publications

References 36 publications

Incidence and Risk Factors for Steatosis Progression in Adults Coinfected With HIV and Hepatitis C Virus

Incidence and Risk Factors for Steatosis Progression in Adults Coinfected With HIV and Hepatitis C Virus

Hepatic Steatosis in Human Immunodeficiency Virus

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

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