Hepatic steatosis is associated with fibrosis, nucleoside analogue use, and hepatitis C virus genotype 3 infection in HIV-seropositive patients.
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.
McGovern
Barbara H
BH
HIV/HCV Co-infection Clinic, Lemuel Shattuck Hospital, Jamaica Plain, Jamaica Plain, MA 02494, USA. bmcgovern@tufts-nemc.org
Ditelberg
Jeremy S
JS
Taylor
Lynn E
LE
Gandhi
Rajesh T
RT
Christopoulos
Katerina A
KA
Chapman
Stacey
S
Schwartzapfel
Beth
B
Rindler
Emily
E
Fiorino
Anne-Marie
AM
Zaman
M Tauheed
MT
Sax
Paul E
PE
Graeme-Cook
Fiona
F
Hibberd
Patricia L
PL
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects; D015897:Comorbidity; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D005838:Genotype; D006679:HIV Seropositivity / Q000453:epidemiology*; D016174:Hepacivirus; D006526:Hepatitis C / Q000145:classification / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000009:adverse effects; D015995:Prevalence; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*
D019380:Anti-HIV Agents; D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors