Hepatic steatosis is associated with fibrosis, nucleoside analogue use, and hepa

July 5, 2006

n Infect Dis. 2006 Aug 1;43(3):365-72. Epub 2006 Jun 22.

Hepatic steatosis is associated with fibrosis, nucleoside analogue use, and

hepatitis C virus genotype 3 infection in HIV-seropositive patients.

McGovern BH, Ditelberg JS, LE, Gandhi RT, Christopoulos KA, Chapman

S, Schwartzapfel B, Rindler E, Fiorino AM, Zaman MT, Sax PE, Graeme-Cook F,

Hibberd PL.

HIV/HCV Co-infection Clinic, Lemuel Shattuck Hospital, Jamaica Plain,

Jamaica Plain, MA 02494, USA. bmcgovern@...

BACKGROUND: We conducted a study to determine the prevalence and factors

associated with hepatic steatosis in human immunodeficiency virus

(HIV)-seropositive patients with hepatitis C and to investigate whether

steatosis is associated with liver fibrosis. METHODS: Retrospective chart

reviews were conducted in 4 hospitals that serve community-based and

incarcerated HIV-infected patients who had undergone a liver biopsy for

evaluation of hepatitis C virus (HCV) infection during the period of

2000-2003. Demographic characteristics and medication and laboratory data

were collected from the time of the biopsy. A pathologist blinded to all

clinical data evaluated the specimens. The primary outcome was presence or

absence of steatosis. RESULTS: Of 260 HIV-HCV-coinfected patients, 183 met

inclusion criteria and had a biopsy specimen adequate for review. Steatosis

was present in 69% of patients (graded as minimal in 31%, mild in 27%,

moderate in 18%, and severe in 1%). Factors associated with steatosis

included use of dideoxynucleoside analogues, such as didanosine and

stavudine (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.55-13.82).

There was a trend toward presence of steatosis and use of other nucleoside

analogues or infection with HCV genotype 3 (OR, 2.65 [95% CI, 0.95-7.41] and

3.38 [95% CI, 0.86-13.28], respectively). The presence of steatosis was

associated with fibrosis (OR, 1.37; 95% CI, 1.03-1.81). CONCLUSIONS: In this

multiracial population of HIV-HCV-coinfected patients, steatosis was

prevalent and was associated with severity of liver fibrosis. Use of

nucleoside analogues (particularly didanosine and stavudine) and HCV

genotype 3 infection were associated with hepatic steatosis. The development

of steatosis is multifactorial in nature and may play a contributory role in

the progression of liver disease in HIV-infected patients.

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July 5, 2006