Coinfection

Liver Steatosis in People with HIV/HCV Coinfection

HIV positive people with chronic hepatitis C virus (HCV) coinfected do not appear more likely to have hepatic steatosis, or fat accumulation in liver cells, than HIV positive individuals, according to a meta-analysis reported in the July 2010 issue of Hepatology. The analysis also saw no association with any class of antiretroviral drugs.

Mariana Verdelho Machado from Hospital Santa Maria in Lisbon and colleagues performed a meta-analysis of hepatic steatosis prevalence and risk factors in HIV/HCV coinfected patients.

Liver steatosis is common in people with hepatitis C, reported in 40%-80% in various studies, the authors noted as background. Past research has linked steatosis to several risk factors including metabolic syndrome and infection with HCV genotype 3. Whether HIV coinfection or use of antiretroviral therapy are also risk factors remains unclear, since prior studies have produced conflicting data.

The researchers identified eligible studies by doing a structured keyword search (including coinfection, HCV, HIV, and steatosis) in relevant databases including PubMed.

Results

• 12 relevant studies were identified, with a total of 1989 HIV/HCV coinfected participants.
• 20% of participants were infected with HCV genotype 3, the type most strongly linked to liver steatosis.
• The overall prevalence of hepatic steatosis was 50.8% (range 23% to 72%).
• 4 studies that also included a total of 1540 HIV negative patients with hepatitis C alone did not show a significant increase in steatosis risk for HIV/HCV coinfected patients (odds ratio [OR] 1.61; P = 0.151).
• Among coinfected patients, hepatic steatosis was significantly associated with higher body mass index (OR 1.13), diabetes (OR 2.32), elevated ALT (OR 1.28), necro-inflammatory activity (OR 1.72), and liver fibrosis (OR 1.67).
• No associations were found, however, between liver steatosis and sex or other metabolic factors including metabolic syndrome and abnormal blood lipid or glucose levels.
• Hepatic steatosis was also not associated with factors related to HCV (viral load, genotype) or HIV (viral load, CD4 count, use of antiretroviral therapy, ART drug class).

Based on these findings, the study authors concluded, "In coinfected patients, hepatic steatosis does not seem to be more frequent than in HCV monoinfected patients and is mostly associated with metabolic factors, such as increased weight, diabetes mellitus, and more severe liver disease."

"The fact that no associations with HCV factors were found may be due to the small percentage of genotype 3-infected patients," they added.

They also saw no link with use of "d-drug" antiretroviral agents -- including didanosine (ddI, Videx) and stavudine (d4T, Zerit) -- which have been reported to cause steatosis and liver enlargement possibly related to mitochondrial toxicity.

Investigator affiliations: Departmento de Gastrenterologia, Unidade de Nutricao e Metabolismo, Hospital Santa Maria, Faculdade de Medicina de Lisboa, IMM, Lisboa, Portugal; Departamento de Bioestatistica, Faculdade de Ciencias Medicas de Lisboa, Lisboa, Portugal.

7/9/10

Reference

MV Machado, AG Oliveira, and H Cortez-Pinto. Hepatic steatosis in patients coinfected with human immunodeficiency virus/hepatitis C virus: a meta-analysis of the risk factors. Hepatology 52(1): 71-78 (Abstract). July 2010.