[Hepatic steatosis: an emerging cause of cirrhosis in HIV patients].
Hepatic steatosis is an emerging cause of morbidity in antiretroviral therapy (ART)-experienced HIV patients. The influence of steatosis on fibrosis is poorly understood. We report two cases of rapid evolution of disseminated macrovacuolar steatofibrosis to cirrhosis. Both patients had no history of alcohol abuse, nor intravenous drug use and were tested negative for HCV (PCR RNA) and had no HBS antigen. Patient 1 had a past history of hypertrygliceridemia, but controlled with dietetic measures for 4 years prior to biopsy. The first hepatic biopsy showed a disseminated macrovacuolar steatosis (>80%). The patient had then cytolysis and an uncontrolled HIV viral load. The second biopsy was performed two years later, and HIV was controlled by a new line of ART. It showed a regression of the steatosis (10%) and a progression of the fibrosis with signs of cirrhosis. Patient 2 had a long history of HIV infection. He also had an uncontrolled dyslipidemia. The first biopsy was realised during a period of uncontrolled HIV infection and elevated liver enzymes. The biopsy showed a major macrovacuolar steatosis (>80%). The second biopsy was realised 6 years after and showed the same steatosis and signs of cirrhosis. The HIV infection was then under control. Observations reported here show a rapid evolution of liver steatosis to cirrhosis in HIV positive / HCV negative patients, despite the control of HIV infection. The implication of HAART remains unclear. In the era of HAART, liver steatosis can rapidly evoluate to cirrhosis without any risk factor except ART.
Loulergue
P
P
Service des maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France. pierre.loulergue@nck.aphp.fr
Callard
P
P
Bonnard
P
P
Pialoux
G
G
D000328:Adult; D005234:Fatty Liver / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity