Abstract
Background and aimsPatients with HIV and hepatitis C virus (HCV) coinfection are at increased risk of developing hepatic steatosis. The aims of this study were to assess the prevalence of steatosis in a cohort with HIV-HCV coinfection, and to determine an association, if any, between steatosis, antiretroviral therapy (ART), and advanced hepatic fibrosis.Patients and methodsHIV-HCV coinfected patients were retrospectively identified from the HIV clinic. ART was classified as none, nucleoside reverse transcriptase inhibitors (NRTIs) only, highly active antiretroviral therapy (HAART) only, and sequential therapy (initial NRTIs followed by HAART). Fibrosis stage and necroinflammation grade were assessed by the modified HAI (Ishak) scoring method. Steatosis was graded as 0–3.ResultsSixty patients were identified. The overall prevalence of hepatic steatosis was 58%. Those that received HAART only had a lower prevalence of steatosis (41%) compared to those on NRTIs only (70%) or sequential therapy (82%). Independent predictors of hepatic steatosis were absence of HAART only therapy, OR 2.9, p = 0.09, and presence of cirrhosis, OR 4.6, p = 0.044. Forty five percent of the patients had advanced fibrosis (fibrosis stage ≥ 3). NI grade (OR 1.9, p = 0.030), and steatosis grade (OR 3.6, p = 0.045), were independent predictors of advanced fibrosis.ConclusionHepatic steatosis is associated with more advanced hepatic fibrosis in the HIV-HCV coinfected population. HAART only therapy (rather than NRTIs only or sequential therapy) appears to be associated with a lower prevalence of hepatic steatosis. This may be one of the mechanisms by which HAART could attenuate hepatic fibrosis in such a cohort.
Highlights
Active antiretroviral therapy (HAART) has significantly improved survival in patients with human immunodeficiency virus (HIV) infection [1]
Hepatic steatosis is associated with more advanced hepatic fibrosis in the HIV-hepatitis C virus (HCV) coinfected population
Factors associated with more advanced hepatic fibrosis in HCV infection include HIV coinfection [3] and hepatic steatosis, [4,5,6]
Summary
Active antiretroviral therapy (HAART) has significantly improved survival in patients with human immunodeficiency virus (HIV) infection [1]. Factors associated with more advanced hepatic fibrosis in HCV infection include HIV coinfection [3] and hepatic steatosis, (prevalence of 47%–79%) [4,5,6]. Patients with HIV are at increased risk of developing hepatic steatosis due to multiple factors including antiretroviral therapy (ART), obesity, hyperglycemia, lipodystrophy, and coinfection with HCV [2,7,8,9,10,11]. Patients with HIV and hepatitis C virus (HCV) coinfection are at increased risk of developing hepatic steatosis. The aims of this study were to assess the prevalence of steatosis in a cohort with HIV-HCV coinfection, and to determine an association, if any, between steatosis, antiretroviral therapy (ART), and advanced hepatic fibrosis
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