Predictors of severe hepatic steatosis using abdominal ultrasound in HIV-infected patients.
OBJECTIVE
Multiple factors may lead to hepatic steatosis (HS) in HIV-positive patients. HS may result in severe liver damage on its own and/or by accelerating the progression of chronic viral hepatitis B or C.


METHODS
The sensitivity/specificity of liver ultrasound (US) to recognize severe HS is above 85%. A cross-sectional case-control study of all HIV out-patients who underwent liver US since 2004 was conducted at our institution.


RESULTS
Eight hundred and thirty (36.1%) out of 2300 HIV-positive patients on regular follow-up underwent liver US during the study period. Severe HS was diagnosed in 108 (13%) patients. A total of 117 matched HIV controls lacking HS were selected randomly. In patients with severe HS, we found significantly higher values of body mass index (BMI), plasma viral load, serum glucose, alkaline phosphatase, triglycerides and low-density lipoprotein cholesterol, as well as significantly higher prevalence of diabetes, elevated alcohol consumption, lipohypertrophy and advanced liver fibrosis. Furthermore, a trend towards longer exposure to nucleoside analogues was noticed. In the multivariate analysis, only elevated alcohol consumption [odds ratio (OR) 7, P=0.013], lipohypertrophy (OR 5.3, P=0.008), plasma viral load (OR 2.1, P=0.02), BMI (OR 1.2, P=0.013) and serum glucose (OR 1.03, P=0.027) were significantly associated with severe HS.


CONCLUSIONS
Severe HS in HIV-positive patients is associated with predisposing factors that are similar to those of HIV-negative individuals. However, its characteristic association with elevated plasma viral load might suggest a direct involvement of HIV in liver fat deposition. Therefore, the benefit of controlling HIV replication with antiretroviral therapy should be balanced against its effect of occasionally inducing metabolic abnormalities and lipodystrophy.
Ryan
P
P
Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
Blanco
F
F
García-Gascó
P
P
García-Merchán
Ja
J
Vispo
E
E
Barreiro
P
P
Labarga
P
P
González-Lahoz
J
J
Soriano
V
V
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D004812:Epidemiologic Methods; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000209:etiology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1; D019694:Hepatitis B, Chronic / Q000821:virology; D019698:Hepatitis C, Chronic / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D008297:Male; D011237:Predictive Value of Tests; D014463:Ultrasonography; D019562:Viral Load