title: Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus.
abstract: OBJECTIVE
  To ascertain the prevalence and severity of hepatic steatosis among patients coinfected with HIV and hepatitis C virus (HCV) who had been taking antiretroviral therapy (ART); to investigate if steatosis is associated with more advanced liver disease, and to identify factors that might contribute to the process.
  
  
  METHODS
  Steatosis was assessed among a randomly selected subset of HIV-HCV-coinfected patients who had received at least 2 years of ART in a cohort study at the Johns Hopkins University HIV clinic. Liver histology was evaluated by a single pathologist. The primary outcome measure was the hepatic steatosis grade, which was classified on a 5 point scale: 0, none; 1, steatosis involving < 5% of hepatocytes; 2, 5-29%; 3, 30-60%; 4 > 60%.
  
  
  RESULTS
  Liver histology was assessed in 112 patients, 74% of whom were taking ART at the time of biopsy. The median cumulative exposure to nucleoside reverse transcriptase inhibitors and protease inhibitors was 5.8 and 3.7 years, respectively. No steatosis was detected in 60%; grades 2-4 steatosis was recognized in 18%. In multivariate analysis, steatosis was independently associated with Caucasian race, weight > 86 kg, hyperglycemia, and stavudine use. Patients with steatosis also were more likely to have greater hepatic fibrosis (P = 0.02) and necroinflammatory activity (P = 0.005).
  
  
  CONCLUSIONS
  Steatosis was observed in 40% of HIV-HCV-coinfected patients with extensive ART exposure and was associated with more severe HCV-related liver disease. Metabolic abnormalities (excess weight and hyperglycemia) and stavudine use were modifiable risk factors for steatosis in this population.
authors.affiliation: Division of Infectious Diseases Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. msulkows@jhmi.edu
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sulkowski
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Michael
authors.initials: M
authors.lastname: Torbenson
authors.forename: Nezam H
authors.initials: NH
authors.lastname: Afdhal
authors.forename: Lisa
authors.initials: L
authors.lastname: Mirel
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
mesh_terms: D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005234:Fatty Liver / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008297:Male; D008875:Middle Aged