Prospective evaluation of hepatic steatosis in HIV-infected patients with or without hepatitis C virus co-infection

Vecchi, Valentina Li; Soresi, Maurizio; Giannitrapani, Lydia; Carlo, Paola Di; Mazzola, Giovanni; Colletti, Pietro; Terranova, Antonino; Vizzini, Giovanni; Montalto, Giuseppe

doi:10.1016/j.ijid.2012.01.011

Cited by 38 publications

(35 citation statements)

References 41 publications

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“…Given the scope of the disease, affecting an estimated 30% of the US population(22), a safe, inexpensive, reliable method of HS screening is critical. This is especially important in the setting of HIV infection: several studies indicate HS is common in HIV-infected individuals, ranging from 28–54% in HIV-monoinfected groups(8, 12, 14, 23–25), but the pathophysiology and implications of HS in this population are not well understood.…”

Section: Discussionmentioning

confidence: 99%

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

Price¹,

Dodge

Ma³

et al. 2017

Aids

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Objective Hepatic steatosis (HS) is common in HIV-infected individuals. Magnetic resonance spectroscopy (MRS) is the preferred non-invasive method for HS measurement but is expensive. Controlled attenuation parameter (CAP) also assesses HS and is conveniently performed concomitantly with transient elastography. We aimed to assess the accuracy of CAP in the setting of HIV infection. Design Cross-sectional study Methods CAP and MRS were performed in 82 subjects (39 HIV-monoinfected;7 HCV-monoinfected;21 HIV/HCV-coinfected; 15 with neither infection). We used concordance correlation coefficients to compare log-transformed and standardized CAP and MRS values and linear regression to examine factors associated with CAP and MRS-measured HS. The accuracy of CAP to detect ≥mild HS, defined as MRS-liver fat fraction ≥0.05, and the factors associated with discordance between CAP and MRS were evaluated. Results Overall, CAP-HS and MRS-HS correlated moderately well (r=0.60, p<0.001), and correlation was strongest in the HIV-monoinfected group (r=0.67, p<0.001). Body composition factors (higher BMI, waist circumference, visceral and abdominal subcutaneous adipose tissue) and insulin resistance were significantly associated with both greater CAP-HS and MRS-HS. Using a validated CAP cut-off ≥238 decibels/meter, sensitivity and specificity for ≥mild HS were 84% and 75% in the entire cohort; 89% and 80% in the HIV-monoinfected group. Higher body composition parameters were more likely to be misclassified as having HS by CAP. Conclusions Our findings suggest CAP is an acceptable non-invasive surrogate for HS in HIV-infected individuals but may overestimate HS prevalence, especially in individuals with high BMI. Evaluation of factors that improve CAP accuracy and determination of optimal cut-offs are warranted.

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Section: Discussionmentioning

confidence: 99%

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

Price¹,

Dodge

Ma³

et al. 2017

Aids

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“…Lo stesso virus HIV può rappresentare una causa diretta di steatosi, come dimostrato in letteratura (7,44,45), e anche la terapia antiretrovirale può avere un ruolo. L'esposizione a NRTI (9,20) e la durata dell'infezione da HIV (13,38) sono stati enunciati come fattori di rischio significativi per lo sviluppo di NAFLD. Resta da valutare il possibile ruolo degli inibitori dell'integrasi rispetto ad altre classi di farmaci per quanto riguarda la reversibilità della NAFLD (40).…”

Section: Discussioneunclassified

“…La prevalenza di NAFLD nelle persone con infezione da HIV (PLHIV) su biopsie epatiche di pazienti con ipertransaminasemia è risultata elevata (>50%) con un'alta percentuale di NASH (7)(8)(9)(10)(11)(12). Considerando le diagnosi eseguite con metodiche diagnostiche non invasive (ecografia, fibroscan, TAC e risonanza magnetica) la prevalenza di NAFLD si aggira tra il 13% e il 58% nei diversi studi pubblicati (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Tale ampio intervallo di variabilità è giustificato dall'uso di diverse definizioni di NAFLD, dai differenti criteri di selezione dei pazienti e dall'uso di metodiche strumentali non sovrapponibili in termini di sensibilità e specificità.…”

Section: Riassuntounclassified

“…I fattori di rischio rilevati più frequentemente sono rappresentati da alti valori del modello omeostatico per la determinazione dell'insulino-resistenza (HOMA-IR) (7, 10-12) ed il BMI elevato (12,36). Gli studi che hanno utilizzato come metodica l'ecografia hanno riportato una prevalenza di steatosi epatica tra il 31% ed il 55% (13)(14)(15)(16)36). I tre studi che hanno escluso dalla analisi i pazienti con abuso alcolico mostravano una prevalenza di NAFLD tra il 31% ed il 47,7% (15,16,36).…”

Section: Definizioni E Diagnosiunclassified

“…I tre studi che hanno escluso dalla analisi i pazienti con abuso alcolico mostravano una prevalenza di NAFLD tra il 31% ed il 47,7% (15,16,36). I fattori di rischio maggiormente rappresentati erano costituiti dalla dislipidemia (13,15) e dall'HOMA-IR (14,16). Gli studi basati sulla determinazione del CAP hanno rilevato una prevalenza di steatosi epatica del 39-51,5% (17-19, 37, 38).…”

Section: Definizioni E Diagnosiunclassified

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La steatosi epatica non alcolica in HIV: una revisione critica della letteratura.

Squillace¹,

Gori²,

Bandera³

2018

JHA

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La steatosi epatica non alcolica in HIV:una revisione critica della letteratura. Non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) in HIV: a critical review. IntroduzioneLa steatosi epatica non alcolica (non alcoholic fatty liver disease, NAFLD) rappresenta una causa emergente di cirrosi e di carcinoma epatocellulare, a causa del diretto legame con l'insorgenza della steatoepatite non alcolica (NASH) (1, 2). La prevalenza di NAFLD nella popolazione generale è influenzata fortemente dall'area geografica di appartenenza, variando dal 7.1% in Nigeria (3) al 42% in Cina (4). Tali variazioni sarebbero imputabili sia a fattori genetici che a differenti regimi dietetici. Obesità, diabete mellito, dislipidemia e sindrome metabolica sono cause note di NAFLD primaria; il ruolo del genere e della razza non sono ancora ben definiti (5), sebbene sia stato rilevato un ruolo significativo del sesso maschile e della razza bianca

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Human immunodeficiency virus–infected and uninfected adults with non–genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection

Price

Scherzer

et al. 2017

Hepatology

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Background Hepatic steatosis (HS) is common in persons with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, but the independent contributions of HCV and HIV to HS is unclear. Methods Magnetic resonance imaging and spectroscopy were used to measure visceral adipose tissue (VAT) and liver fat fraction (LFF) [total lipids/(total lipids+water)] in 356 adults: 57 HCV-monoinfected, 70 HIV/HCV-coinfected, 122 HIV-monoinfected, and 107 HIV/HCV-uninfected. Genotype 3 HCV-infected participants were excluded due to the genotype's reported steatogenic effects. For prevalence estimates, HS was defined as LFF≥0.05. We estimated the association of HIV and HCV status with LFF using multivariable linear regression, adjusting for demographic, lifestyle, and metabolic factors including the homeostasis model assessment estimate of insulin resistance (HOMA-IR) and liver fibrosis defined using the AST-to-platelet ratio index (APRI). Results The prevalence of HS was highest in the uninfected(33%) and HIV-monoinfected(28%), followed by the HCV-monoinfected(19%) and HIV/HCV-coinfected(11%)(p=0.003 across groups). Compared to uninfected participants, after adjusting for demographic, lifestyle, and metabolic factors, HIV monoinfection, HCV monoinfection and HIV/HCV coinfection were associated with 19%(95%CI:-39%,6%), 38%(95%CI:-55%,-12%) and 42%(95%CI:-59%,-18%) lower LFF, respectively. HCV monoinfection and HIV/HCV coinfection remained strongly associated with lower LFF after further adjusting for APRI, and results were unchanged after excluding subjects with suspected cirrhosis. Among the entire cohort, Hispanic ethnicity, male sex, VAT, and HOMA-IR were independently associated with greater LFF. Conclusions Contrary to expectations, HIV/HCV-coinfected and HCV-monoinfected adults had significantly less liver fat than uninfected adults, even after adjusting for demographic, lifestyle, metabolic factors, and hepatic fibrosis. Our findings suggest that non-genotype 3 HCV infection may be protective against HS. The mechanisms by which this occurs and impact of HCV treatment on HS need investigation.

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Prospective evaluation of hepatic steatosis in HIV-infected patients with or without hepatitis C virus co-infection

Cited by 38 publications

References 41 publications

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

La steatosi epatica non alcolica in HIV: una revisione critica della letteratura.

Human immunodeficiency virus–infected and uninfected adults with non–genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection

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