title: Hepatic steatosis is associated with fibrosis, nucleoside analogue use, and hepatitis C virus genotype 3 infection in HIV-seropositive patients.
abstract: 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.
authors.affiliation: HIV/HCV Co-infection Clinic, Lemuel Shattuck Hospital, Jamaica Plain, Jamaica Plain, MA 02494, USA. bmcgovern@tufts-nemc.org
authors.forename: Barbara H
authors.initials: BH
authors.lastname: McGovern
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Ditelberg
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Taylor
authors.forename: Rajesh T
authors.initials: RT
authors.lastname: Gandhi
authors.forename: Katerina A
authors.initials: KA
authors.lastname: Christopoulos
authors.forename: Stacey
authors.initials: S
authors.lastname: Chapman
authors.forename: Beth
authors.initials: B
authors.lastname: Schwartzapfel
authors.forename: Emily
authors.initials: E
authors.lastname: Rindler
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Fiorino
authors.forename: M Tauheed
authors.initials: MT
authors.lastname: Zaman
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sax
authors.forename: Fiona
authors.initials: F
authors.lastname: Graeme-Cook
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: 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*
chemical_list: D019380:Anti-HIV Agents; D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors