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Hepatic steatosis in patients with HIV-Hepatitis C Virus coinfection: is it associated with antiretroviral therapy and more advanced hepatic fibrosis?

Verma S, Goldin RD, Main J - BMC Res Notes (2008)

Bottom Line: Hepatic 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hepatology Section, Department of Medicine, Imperial College at St Mary's Hospital, London, UK. s.verma@bsms.ac.uk

ABSTRACT

Background and aims: 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.

Patients and methods: HIV-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.

Results: Sixty 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.

Conclusion: Hepatic 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.

No MeSH data available.


Related in: MedlinePlus

Prevalence of hepatic steatosis (in percentage) depending on type of therapy received. Number of patients with steatosis in the 4 groups was as follows: Sequential 9/11, NRTI 7/10, No therapy 10/17 and HAART only 9/22. HAART only vs NRTIs only, p = 0.11. HAART only vs sequential therapy, p = 0.064.
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Figure 2: Prevalence of hepatic steatosis (in percentage) depending on type of therapy received. Number of patients with steatosis in the 4 groups was as follows: Sequential 9/11, NRTI 7/10, No therapy 10/17 and HAART only 9/22. HAART only vs NRTIs only, p = 0.11. HAART only vs sequential therapy, p = 0.064.

Mentions: Some degree of hepatic steatosis was present in 58% of the patients, with the majority having grade 1 steatosis (Fig 1). Table 2 shows data in those with and without steatosis. Those who received NRTIs only (70%) or sequential therapy (82%) were more likely to have hepatic steatosis compared to those that received HAART only (41%), p = 0.11 and 0.64 respectively), (Fig 2). The use of HAART only therapy was protective against development of steatosis (Table 2). The mean steatosis grade in the HAART only group was 0.5 ± 0.8. This was lower than that seen in the NRTI only (1.2 ± 1.0, p = 0.20), sequential therapy group (0.9 ± 0.5, p = 0.63), and no therapy group (0.6 ± 0.6). Further sub group analysis indicated the prevalence of steatosis as follow: stavudine (70%), didanosine (61%), zidovudine (63%), any PI therapy (62%), and any NNRTI therapy (58%).


Hepatic steatosis in patients with HIV-Hepatitis C Virus coinfection: is it associated with antiretroviral therapy and more advanced hepatic fibrosis?

Verma S, Goldin RD, Main J - BMC Res Notes (2008)

Prevalence of hepatic steatosis (in percentage) depending on type of therapy received. Number of patients with steatosis in the 4 groups was as follows: Sequential 9/11, NRTI 7/10, No therapy 10/17 and HAART only 9/22. HAART only vs NRTIs only, p = 0.11. HAART only vs sequential therapy, p = 0.064.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2527001&req=5

Figure 2: Prevalence of hepatic steatosis (in percentage) depending on type of therapy received. Number of patients with steatosis in the 4 groups was as follows: Sequential 9/11, NRTI 7/10, No therapy 10/17 and HAART only 9/22. HAART only vs NRTIs only, p = 0.11. HAART only vs sequential therapy, p = 0.064.
Mentions: Some degree of hepatic steatosis was present in 58% of the patients, with the majority having grade 1 steatosis (Fig 1). Table 2 shows data in those with and without steatosis. Those who received NRTIs only (70%) or sequential therapy (82%) were more likely to have hepatic steatosis compared to those that received HAART only (41%), p = 0.11 and 0.64 respectively), (Fig 2). The use of HAART only therapy was protective against development of steatosis (Table 2). The mean steatosis grade in the HAART only group was 0.5 ± 0.8. This was lower than that seen in the NRTI only (1.2 ± 1.0, p = 0.20), sequential therapy group (0.9 ± 0.5, p = 0.63), and no therapy group (0.6 ± 0.6). Further sub group analysis indicated the prevalence of steatosis as follow: stavudine (70%), didanosine (61%), zidovudine (63%), any PI therapy (62%), and any NNRTI therapy (58%).

Bottom Line: Hepatic 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hepatology Section, Department of Medicine, Imperial College at St Mary's Hospital, London, UK. s.verma@bsms.ac.uk

ABSTRACT

Background and aims: 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.

Patients and methods: HIV-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.

Results: Sixty 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.

Conclusion: Hepatic 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.

No MeSH data available.


Related in: MedlinePlus