Monday, September 17, 2012

Hepatic steatosis commonly progressed in HIV/HCV coinfected patients

Hepatic steatosis commonly progressed in HIV/HCV coinfected patients

Macías J. Hepatology. 2012;doi:10.1002/hep.25791.

Patients with HIV and HCV were prone to hepatic steatosis that frequently progressed over time in a recent study.

In the retrospective study, researchers evaluated 146 patients coinfected with HIV and HCV who underwent two biopsies separated by 1 year or more (median 3.3 years). The presence and progression of hepatic steatosis (HS) was monitored within the cohort.
HS was present in 87 patients at the initial biopsy and 113 in the subsequent biopsy (P<.001), with progression detected in 60 participants, including eight who progressed by two or more grades. Eleven participants regressed by one or more grades between biopsies. Change to fasting plasma glucose (OR=1.4; 95% CI, 1.04-1.9 per 10 mg/dL increase) and cumulative dideoxynucleoside analog use (OR=1.5; 95% CI, 1.2-1.8 per year exposed) were associated with HS progression via multivariate analysis.

Liver fibrosis stages were present in the cohort at the following rates (P=.019 for change):
  • Stage 0: 20% of patients at initial biopsy, 12% at second
  • Stage 1: 34% at initial biopsy, 27% at second
  • Stage 2: 19% at initial biopsy, 29% at second
  • Stage 3: 21% at initial biopsy, 16% at second
  • Stage 4: 7.5% at initial biopsy, 16% at second
Progression of one or more fibrotic stages was associated with persistent or onset of steatohepatitis (OR=2.4; 95% CI, 1.01-5.7). At initial biopsy, 24 participants had steatohepatitis, which increased to 27 at the follow-up (P=.602 for difference), including nine persistent cases and 18 patients who progressed to steatohepatitis. Median NAS score increased from 3 to 4 between biopsies (P=.002); 65 participants experienced an increase and 35 a decrease.

“HS is frequently detected in HIV/HCV-coinfected patients with and without [antiretroviral therapy], and high rates of progression to severe HS are observed in them,” the researchers concluded. “This is a major concern, given that among individuals with HS, those with features of steatohepatitis are at increased risk of fibrosis progression. … The natural history of HS and steatohepatitis in HIV/HCV coinfection needs further investigation, particularly in patients receiving the newer antiretroviral drugs.”


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