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Shur NF, Tan Y, Goubet S, Fisher M, Gilleece Y, Verma S. Non-viral liver disease burden in HIV-monoinfected individuals: a longitudinal observational retrospective cohort study. AIDS Care 2016; 28:1522-1527. [PMID: 27263666 DOI: 10.1080/09540121.2016.1191603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recent advances in antiviral therapy have improved outcomes in HIV-positive individuals co-infected with hepatitis B and C virus (HBV/HCV). Our aim was to assess prevalence and predictors of chronic liver disease (CLD) due to the metabolic syndrome (MS), alcohol and antiretrovirals (ARVs) use in HIV-monoinfected individuals. This was a retrospective cohort study (2005-2012). HIV-positive patients with negative HBV/HCV serology and at least two elevated alanine aminotransferase (ALT) levels six months apart were included. Data are presented as mean ± SD or percentage. Despite negative viral serology, 27% (1047/3872) of HIV-positive individuals had persistently elevated ALT. Only 243 (23.2%) were investigated (by imaging in the majority, only 58 undergoing liver biopsy/transient elastography). CLD was identified in 66.2%, this being clinically significant in one in four individuals. Potential CLD risk factors were alcohol (44.2%), hepatotoxic ARVs (74.1%) and MS risk factors (68%) with 68.7% having >1 risk factor. On multivariate logistic regression analysis serum triglyceride (OR 1.482, 95% CI 1.053-2.086, p = .024) was the only independent predictor of CLD. Overall, 4.3% were referred to Hepatology services. In conclusion, less than 6% of HIV-monoinfected individuals with persistently elevated ALT undergo objective assessment of hepatic fibrosis. Despite non-stringent criteria, some degree of non-viral CLD is identified in approximately two-thirds of those investigated, risk factors being synonymous with those for the MS. This increasing yet under-recognised non-viral CLD burden warrants timely recognition to prevent long-term morbidity and mortality.
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Affiliation(s)
- Natalie F Shur
- a Deparment of Gastroenterology and Hepatology , Brighton and Sussex University Hospital , East Sussex , UK
| | - Yishi Tan
- a Deparment of Gastroenterology and Hepatology , Brighton and Sussex University Hospital , East Sussex , UK
| | - Stephanie Goubet
- b Clinical Investigation and Research Unit, Brighton and Sussex University Hospital , East Sussex , UK
| | - Martin Fisher
- c Department of HIV/Genitourinary Medicine , Brighton and Sussex University Hospital, Brighton and Sussex University Hospital , East Sussex , UK.,d Department of Medicine , Brighton and Sussex Medical School , Brighton , UK
| | - Yvonne Gilleece
- c Department of HIV/Genitourinary Medicine , Brighton and Sussex University Hospital, Brighton and Sussex University Hospital , East Sussex , UK
| | - Sumita Verma
- a Deparment of Gastroenterology and Hepatology , Brighton and Sussex University Hospital , East Sussex , UK.,d Department of Medicine , Brighton and Sussex Medical School , Brighton , UK
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Debes JD, Marianelli LG, Frassone N, Ballari E, Castrillon ME, Zhang L, Bohjanen PR, Boulware DR. Fatty Liver in Hispanics with HIV. AIDS Res Hum Retroviruses 2016; 32:515-6. [PMID: 26972020 DOI: 10.1089/aid.2016.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Jose D. Debes
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | - Lei Zhang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Paul R. Bohjanen
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David R. Boulware
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Sebastiani G, Rollet-Kurhajec KC, Pexos C, Gilmore N, Klein MB. Incidence and predictors of hepatic steatosis and fibrosis by serum biomarkers in a large cohort of human immunodeficiency virus mono-infected patients. Open Forum Infect Dis 2015; 2:ofv015. [PMID: 26034765 PMCID: PMC4438895 DOI: 10.1093/ofid/ofv015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background. Longitudinal data on liver disease in human immunodeficiency virus (HIV) mono-infection are scarce. We used noninvasive serum biomarkers to study incidence and predictors of hepatic steatosis and fibrosis. Methods. Hepatic steatosis was diagnosed by hepatic steatosis index ≥36. Advanced liver fibrosis was diagnosed by fibrosis-4 index >3.25. Kaplan-Meier analysis was used to estimate incidences. Cox regression analysis was used to explore predictors of hepatic steatosis and fibrosis development. Results. In this retrospective observational study, 796 consecutive HIV mono-infected patients were observed for a median of 4.9 (interquartile range, 2.2-6.4) years. Incidence of hepatic steatosis was 6.9 of 100 per person-years (PY) (95% confidence interval [CI], 5.9-7.9). Incidence of advanced liver fibrosis was 0.9 of 100 PY (95% CI, 0.6-1.3). Development of hepatic steatosis was predicted by black ethnicity (adjusted hazard ratio [aHR] = 2.18; 95% CI, 1.58-3; P < .001) and lower albumin (aHR = 0.94; 95% CI, 0.91-0.97; P < .001). Development of advanced liver fibrosis was predicted by higher glucose (aHR = 1.22; 95% CI, 1.2-1.3; P < .001) and lower albumin (aHR = 0.89; 95% CI, 0.84-0.93; P < .001). Conclusions. Incident hepatic steatosis is frequent in HIV mono-infected patients, particularly in those of black ethnicity. These patients can also develop advanced liver fibrosis. Identification of at-risk individuals can help early initiation of hepatological monitoring and interventions, such as targeting euglycemia.
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Affiliation(s)
- Giada Sebastiani
- Chronic Viral Illness Service, Department of Medicine , Royal Victoria Hospital, McGill University Health Centre , Montreal , Canada
| | - Kathleen C Rollet-Kurhajec
- Chronic Viral Illness Service, Department of Medicine , Royal Victoria Hospital, McGill University Health Centre , Montreal , Canada
| | - Costa Pexos
- Chronic Viral Illness Service, Department of Medicine , Royal Victoria Hospital, McGill University Health Centre , Montreal , Canada
| | - Norbert Gilmore
- Chronic Viral Illness Service, Department of Medicine , Royal Victoria Hospital, McGill University Health Centre , Montreal , Canada
| | - Marina B Klein
- Chronic Viral Illness Service, Department of Medicine , Royal Victoria Hospital, McGill University Health Centre , Montreal , Canada
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Vodkin I, Valasek MA, Bettencourt R, Cachay E, Loomba R. Clinical, biochemical and histological differences between HIV-associated NAFLD and primary NAFLD: a case-control study. Aliment Pharmacol Ther 2015; 41:368-78. [PMID: 25496369 DOI: 10.1111/apt.13052] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/18/2014] [Accepted: 11/24/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are limited data regarding the clinical, biochemical and liver histological characteristics of patients with HIV-associated nonalcoholic fatty liver disease (NAFLD), and whether this entity differs in presentation and severity from primary NAFLD AIM: To examine the clinical and histological differences between HIV-associated NAFLD and primary NAFLD. METHODS This is a cross-sectional, case-control study comparing patients with HIV-associated NAFLD vs. patients with primary NAFLD. HIV-infected patients were identified from a database of consecutive liver biopsies performed at the University of California at San Diego, over a 13-year period. HIV-infected patients with biopsy-proven NAFLD were selected as cases, after exclusion of other causes of liver disease and hepatic steatosis. Age-sex-matched controls with biopsy-proven primary NAFLD were randomly identified from the same pathology database. All biopsies underwent a standardised, detailed, histological research evaluation by a liver pathologist who was blinded to clinical and case-control status. RESULTS Compared to age-sex-matched patients with primary NAFLD (n = 33), patients with HIV-associated NAFLD (n = 33) had significantly higher mean aspartate aminotransferase (P < 0.001), alanine aminotransferase (P < 0.001), alkaline phosphatase (P = 0.003) and serum triglycerides (P = 0.024). Similarly, compared to age-sex-matched primary NAFLD, patients with HIV-associated NAFLD had significantly higher rates of definite steatohepatitis (37% vs. 63%, P = 0.04), and more features of liver injury, including lobular inflammation (<0.001) and acidophil bodies (<0.001). CONCLUSION Compared to age-sex-matched primary NAFLD, HIV-associated NAFLD has increased severity of liver disease and a higher prevalence of NASH.
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Affiliation(s)
- I Vodkin
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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55
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Da Silva HE, Arendt BM, Noureldin SA, Therapondos G, Guindi M, Allard JP. A Cross-Sectional Study Assessing Dietary Intake and Physical Activity in Canadian Patients with Nonalcoholic Fatty Liver Disease vs Healthy Controls. J Acad Nutr Diet 2014; 114:1181-94. [DOI: 10.1016/j.jand.2014.01.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 01/06/2014] [Indexed: 02/06/2023]
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Xiao J, Han N, Yang D, Zhao H. Liver steatosis in Chinese HIV-infected patients with hypertriglyceridemia: characteristics and independent risk factors. Virol J 2013; 10:261. [PMID: 23941464 PMCID: PMC3765514 DOI: 10.1186/1743-422x-10-261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/09/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Since Highly Active Antiretroviral Therapy (HAART) medications were made available in 2002, multiple serious side effects have been observed. However, no study has yet systematically evaluated the prevalence of liver steatosis, a very serious but treatable side effect. OBJECTIVES This study examined the prevalence of and independent risk factors for liver steatosis in Chinese HIV-infected, HAART-experienced patients who had been diagnosed with hypertriglyceridemia. METHODS In this cross-sectional observational study, the prevalence of liver steatosis was determined by ultrasound imaging that detected diffusion in hepatic echogenicity. The risk factors associated with steatosis were evaluated with a proportional odds logistic regression model. RESULTS Among 163 HIV-infected patients with hypertriglyceridemia and past HAART experience, 75(46%) patients were determined to have liver steatosis. In multivariable logistic regression model, the risk factors associated with liver steatosis were: higher triglyceride level (OR = 1.086, P = 0.026), metabolic syndromes (OR = 2.092, P = 0.024) and exposure to nucleoside reverse transcriptase inhibitor (NRTIs) ((OR = 2.11, P = 0.001) and Stavudine (OR = 3.75, P = 0.01)). Exposure to Nevirapine (OR = 0 .41, P = 0.003) was a favorable factor for lipid metabolism in vivo and was a protective factors for liver steatosis. CONCLUSIONS Chinese HIV-infected patients with hypertriglyceridemia appear to be prone to liver steatosis, especially those on NRTIs. Routine screening should be considered on their lipid panels.
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Affiliation(s)
- Jiang Xiao
- The Center of Infectious Diseases, Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ning Han
- The Center of Infectious Diseases, Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Di Yang
- The Center of Infectious Diseases, Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hongxin Zhao
- The Center of Infectious Diseases, Ditan Hospital, Capital Medical University, Beijing 100015, China
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Abstract
Nonalcoholic steatohepatitis (NASH) is defined histopathologically by the presence of macrovesicular steatosis, cellular ballooning, and inflammation. NASH represents a complex multifactorial disease that typically occurs within the context of the metabolic syndrome. NASH lacks homogeneity, and other forms of NASH can present atypically. Less than 50% of patients with NASH respond to pharmacologic treatment, which speaks to this heterogeneity. The authors discuss drugs, disease entities, and nutritional states that can cause or exacerbate underlying NASH indirectly through worsening insulin resistance or directly by interfering with lipid metabolism, promoting oxidative injury, or activating inflammatory pathways.
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Affiliation(s)
- Soledad Larrain
- Division of Gastroenterology & Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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58
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Crane M, Iser D, Lewin SR. Human immunodeficiency virus infection and the liver. World J Hepatol 2012; 4:91-8. [PMID: 22489261 PMCID: PMC3321495 DOI: 10.4254/wjh.v4.i3.91] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 11/04/2011] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
Liver disease in human immunodeficiency virus (HIV)-infected individuals encompasses the spectrum from abnormal liver function tests, liver decompensation, with and without evidence of cirrhosis on biopsy, to non-alcoholic liver disease and its more severe form, non-alcoholic steatohepatitis and hepatocellular cancer. HIV can infect multiple cells in the liver, leading to enhanced intrahepatic apoptosis, activation and fibrosis. HIV can also alter gastro-intestinal tract permeability, leading to increased levels of circulating lipopolysaccharide that may have an impact on liver function. This review focuses on recent changes in the epidemiology, pathogenesis and clinical presentation of liver disease in HIV-infected patients, in the absence of co-infection with hepatitis B virus or hepatitis C virus, with a specific focus on issues relevant to low and middle income countries.
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Affiliation(s)
- Megan Crane
- Megan Crane, Sharon R Lewin, Department of Medicine, Monash University, Melbourne 3004, Australia
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From nonalcoholic fatty liver to nonalcoholic steatohepatitis and cirrhosis in HIV-infected patients. Curr Opin Infect Dis 2012; 25:10-6. [DOI: 10.1097/qco.0b013e32834ef599] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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60
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Guaraldi G, Lonardo A, Ballestri S, Zona S, Stentarelli C, Orlando G, Carli F, Carulli L, Roverato A, Loria P. Human immunodeficiency virus is the major determinant of steatosis and hepatitis C virus of insulin resistance in virus-associated fatty liver disease. Arch Med Res 2012; 42:690-7. [PMID: 22227046 DOI: 10.1016/j.arcmed.2011.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/08/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS To promote our understanding of the relative contribution of metabolic and viral factors, the independent predictors of fatty liver and insulin resistance (IR) were assessed by comparing patients with nonalcoholic fatty liver disease (NAFLD) to individuals with virus-associated fatty liver disease (VAFLD): human immunodeficiency virus (HIV)-VAFLD, hepatitis C virus (HCV)-VAFLD and HIV-HCV-VAFLD. METHODS One hundred eighty eight consecutive patients with viral infections (103 HIV, 85 patients with HCV genotype 1 infection: 45 mono-infected and 40 HIV/HCV co-infected) with or without steatosis and 126 NAFLD patients were analyzed. Steatosis was diagnosed by ultrasonography. To assess the odds ratio (OR) of steatosis and IR, HCV and NAFLD, respectively, were used as the reference values. IR was evaluated through homeostasis model (HOMA) and the metabolic syndrome (MetS) using standard criteria. RESULTS The prevalence of VAFLD was 47%. Multivariate logistic regression analysis was carried out using HCV as the reference. VAFLD was predicted by HIV, HIV/HCV, female gender, waist circumference (WC) and HOMA (OR = 3.99, 3.76, 2.80, 1.08 and 1.18). According to multiple linear regression using NAFLD as the reference, IR was predicted by HCV, HIV and HIV/HCV, WC, triglycerides (coefficient beta = 2.25, 0.99, 1.86, 0.08, 0.05, respectively). In linear models, for any given number of components of MetS, HCV and HCV/HIV-associated fatty liver disease had greater HOMA compared to NAFLD (p <0.001). CONCLUSIONS Whereas HIV confers a higher risk of steatosis, VAFLD is associated with higher IR than NAFLD and such an effect is specifically linked to HCV rather than to HIV infection.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Medicine and Medical Specialties, Metabolic Clinic, Infectious and Tropical Disease Unit, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
PURPOSE OF REVIEW Liver disease is a major cause of morbidity and mortality in HIV-infected persons. The long-term beneficial versus potentially harmful influence of antiretroviral therapy (ART) on the liver is debated. We review current data on factors contributing to liver disease in HIV-monoinfected as well as in HIV/viral hepatitis-coinfected patients, highlighting the role of ART, HIV itself, immunodeficiency, patient characteristics, and lifestyle risk factors. RECENT FINDINGS New ART-related clinical syndromes, including noncirrhotic portal hypertension and nonalcoholic fatty liver disease, have emerged, and observational data suggest long-term ART-associated liver injury. Recently, there is increasing evidence that HIV itself and immunosuppression are contributing to liver injury in both HIV-coinfected and HIV-monoinfected patients. In HIV-positive persons, ART attenuates progression of chronic viral hepatitis. SUMMARY Current expert guidelines recommend earlier treatment of HIV infection in persons coinfected with hepatitis B virus and possibly hepatitis C virus. It is unknown whether an earlier start of ART is beneficial for the liver in HIV-monoinfected patients. Future research should focus on long-term ART-related hepatotoxicity.
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Abstract
Introduction of effective combined antiretroviral therapy has made HIV infection a chronic illness. Substantial reductions in the number of AIDS-related deaths have been accompanied by an increase in liver-related morbidity and mortality due to co-infection with chronic hepatitis B and C viruses. Increases in non-alcoholic fatty liver disease and drug-induced hepatotoxicity, together with development of hepatocellular carcinoma, also potentiate the burden of liver disease in individuals with HIV infection. We provide an overview of the key causes, disease mechanisms of pathogenesis, and recommendations for treatment options including the evolving role of liver transplantation.
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Affiliation(s)
- Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
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Serum FGF21 levels are elevated in association with lipodystrophy, insulin resistance and biomarkers of liver injury in HIV-1-infected patients. AIDS 2010; 24:2629-37. [PMID: 20935553 DOI: 10.1097/qad.0b013e3283400088] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE HIV-1-infected patients with lipodystrophy show insulin resistance, dyslipidemia and other signs of metabolic syndrome. Fibroblast growth factor-21 (FGF21) is a novel metabolic regulator that has been suggested to exert beneficial effects on metabolic homeostasis and insulin sensitivity. Our goal was to determine the relationship between FGF21 levels and metabolic alterations in these patients. RESEARCH DESIGN AND METHODS Serum FGF21 levels were analyzed in 179 individuals belonging to four groups: HIV-1-infected, antiretroviral-treated patients that have developed lipodystrophy (n = 59); HIV-1-infected, antiretroviral-treated patients without lipodystrophy (n = 45); untreated (naive) HIV-1-infected patients (n = 41); and healthy control individuals (n = 34). Serum FGF21 levels were correlated with parameters indicative of altered fat distribution, metabolic and cardiovascular risk, and in relation to HIV-1 infection and antiretroviral treatment regimens. RESULTS Serum FGF21 levels were increased in all HIV-1-infected patients, but the increases were most marked in those with lipodystrophy. FGF21 levels showed a strong positive correlation with indicators of lipodystrophy (trunk/apendicular fat ratio, waist-to-hip ratio), insulin resistance (fasting glucose, HOMA-R), dyslipidemia (low-density lipoprotein cholesterol), and liver injury (γ-glutamyltransferase). CONCLUSIONS FGF21 levels are increased in HIV-1-infected patients, especially in those with lipodystrophy, and this increase is closely associated with insulin resistance, metabolic syndrome and makers of liver damage. Further research will be required to determine whether the increase in FGF21 levels is caused by a compensatory response or resistance to FGF21, and to establish the potential of FGF21 as a biomarker of altered metabolism in HIV-1-infected, antiretroviral-treated patients.
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Machado MV, Oliveira AG, Cortez-Pinto H. Hepatic steatosis in patients coinfected with human immunodeficiency virus/hepatitis C virus: a meta-analysis of the risk factors. Hepatology 2010; 52:71-8. [PMID: 20578130 DOI: 10.1002/hep.23619] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED Hepatic steatosis (HS) is frequent in patients with hepatitis C virus (HCV) infection, occurring in 40%-80%, associating with metabolic and virus-related factors, namely, genotype 3 and viral load. Human immunodeficiency virus (HIV) infection and antiretroviral treatment seem to be risk factors for HS. Several studies addressed this issue in coinfected patients, with discrepant results. A meta-analysis was performed on the HS risk factors in coinfected patients. Eligible studies were identified through structured keywords including coinfection, HCV, HIV, and steatosis in relevant databases including PubMed. Pooled odds ratios (ORs) and confidence limits (CIs) were obtained with the random-effects model and the DerSimonian-Laird method. Twelve studies, including 1,989 coinfected patients, were selected. Twenty percent were infected with HCV genotype 3. The overall prevalence of HS was 50.8% (23%-72%). Four studies also included 1,540 HCV monoinfected patients, not showing an increased risk for HS in coinfected patients (OR 1.61, 95% CI 0.84-3.10, P = 0.151). In coinfected patients, HS was associated with higher body mass index (OR 1.13, 95% CI 1.07-1.19, P < 0.001), diabetes mellitus (OR 2.32, 95% CI 1.32-4.07, P = 0.003), elevated alanine aminotransferase levels (OR 1.28, 95% CI 1.02-1.61, P = 0.035), necroinflammatory activity (OR 1.72, 95% CI 1.11-2.67, P = 0.016), and fibrosis (OR 1.67, 95% CI 1.20-2.34, P = 0.003). No associations were found between HS and gender, other metabolic factors (dyslipidemia, glucose, metabolic syndrome), HCV-related factors (genotype, viral load), or HIV-related factors (viral load, CD4 count, antiretroviral therapy, and class of medication). CONCLUSION In coinfected patients, HS 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.
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Affiliation(s)
- Mariana Verdelho Machado
- Departmento de Gastrenterologia, Unidade de Nutrição e Metabolismo, Hospital Santa Maria, Faculdade de Medicina de Lisboa, IMM, Lisboa, Portugal
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Villarroya F, Domingo P, Giralt M. Drug-induced lipotoxicity: Lipodystrophy associated with HIV-1 infection and antiretroviral treatment. Biochim Biophys Acta Mol Cell Biol Lipids 2010; 1801:392-9. [DOI: 10.1016/j.bbalip.2009.09.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 09/09/2009] [Accepted: 09/17/2009] [Indexed: 12/24/2022]
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66
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PPAR and liver injury in HIV-infected patients. PPAR Res 2009; 2009:906167. [PMID: 19390649 PMCID: PMC2669659 DOI: 10.1155/2009/906167] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 01/31/2009] [Indexed: 01/14/2023] Open
Abstract
Due to the introduction of active HIV antiretroviral treatment, AIDS-related morbidity and mortality have markedly decreased and liver diseases are now a major cause of morbidity and mortality in HIV-infected patients. Chronic liver injury encompasses a wide spectrum of diseases due to HCV and HBV coinfection, drug-related toxicity, and NASH. HIV-infected patients who are receiving treatment present with a high prevalence of metabolic complications and lipodystrophy. Those patients are at high risk of nonalcoholic fatty liver disease, the liver feature of the metabolic syndrome. This review will focus on (1) the liver injuries in HIV-infected patients; (2) both the current experimental and human data regarding PPAR and liver diseases; (3) the interactions between HIV and PPAR; (4) the potential use of PPAR agonists for the management of HIV-related liver diseases.
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Pascual Pareja JF, Camino A, Larrauri J, López-Diéguez M, Montes ML, González-García J, Peña JM, Díez J, Arribas JR. Factores asociados con esteatosis hepática en pacientes coinfectados por los virus de la inmunodeficiencia humana y de la hepatitis C. Med Clin (Barc) 2009; 132:208-13. [DOI: 10.1016/j.medcli.2008.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 04/03/2008] [Indexed: 01/27/2023]
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68
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Guaraldi G, Squillace N, Stentarelli C, Orlando G, D'Amico R, Ligabue G, Fiocchi F, Zona S, Loria P, Esposito R, Palella F. Nonalcoholic fatty liver disease in HIV-infected patients referred to a metabolic clinic: prevalence, characteristics, and predictors. Clin Infect Dis 2008; 47:250-7. [PMID: 18532884 DOI: 10.1086/589294] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence and predictors of nonalcoholic fatty liver disease (NAFLD) in human immunodeficiency virus (HIV)-infected highly active antiretroviral therapy-experienced patients and the association of NAFLD with risk of cardiovascular disease and subclinical atherosclerosis are unknown. METHODS We performed a cross-sectional observational study. NAFLD was defined by liver-spleen attenuation values of <1.1 on computed tomography in persons who had neither evidence of chronic viral hepatitis nor a significant history of alcohol consumption. RESULTS We enrolled 225 patients; 163 (72.4%) were men. Mean (+/-SD) HIV infection duration was 145 +/- 60 months, and mean (+/-SD) body mass index (calculated as weight in kilograms divided by the square of height in meters) was 23.75 +/- 3.59. NAFLD was diagnosed in 83 patients (36.9% of the total cohort). The following variables were significantly associated with NAFLD in univariate analyses: sex, waist circumference, body mass index, cumulative exposure to nucleoside reverse-transcriptase inhibitors, visceral adipose tissue, homeostasis model assessment of insulin resistance index, serum alanine and aspartate aminotransferase levels, and ratios of total serum cholesterol to high-density lipoprotein cholesterol. Coronary artery calcium scores and a diagnosis of diabetes were not associated with NAFLD. In multivariable logistic regression analyses, factors associated (P<0.001) with NAFLD were higher serum alanine to aspartate ratio (odds ratio, 4.59; 95% confidence interval, 2.09-10.08), male sex (odds ratio, 2.49; 95% confidence interval, 1.07-5.81), greater waist circumference (odds ratio, 1.07; 95% confidence interval, 1.03-1.11), and longer nucleoside reverse-transcriptase inhibitor exposure (odds ratio, 1.12 per year of exposure; 95% confidence interval, 1.03-1.22). CONCLUSIONS NAFLD is common among HIV-infected persons who have the traditional risk factors for NAFLD (elevations in serum alanine level, male sex, and increased waist circumference) apparent. Exposure to nucleoside reverse-transcriptase inhibitors was an independent risk factor for NAFLD, with an 11% increase in the odds ratio for each year of use.
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Affiliation(s)
- Giovanni Guaraldi
- University of Modena and Reggio Emilia School of Medicine, Modena, Italy.
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