title: Association of HIV infection, hepatitis C virus infection, and metabolic factors with liver stiffness measured by transient elastography.
abstract: BACKGROUND
  Few studies have examined the relationship of human immunodeficiency virus (HIV) monoinfection and its associated perturbations with liver fibrosis.
  
  
  METHODS
  USING multivariable linear regression, we examined the demographic, behavioral, metabolic and viral factors associated with transient elastography-measured liver stiffness in 314 participants (165 HIV positive/hepatitis C virus [HCV] negative, 78 HIV positive/HCV positive, 14 HIV negative/HCV positive, 57 HIV negative/HCV negative) in the Women's Interagency HIV Study.
  
  
  RESULTS
  Compared with HIV negative/HCV negative women, HIV positive/HCV positive women had higher median liver stiffness values (7.1 vs 4.4 kPa; P < .001); HIV positive/HCV negative and HIV negative/HCV negative women had similar liver stiffness values (both 4.4 kPa; P = .94). HIV/HCV coinfection remained associated with higher liver stiffness values (74% higher; 95% confidence interval [CI], 49-104) even after multivariable adjustment. Among HCV positive women, waist circumference (per 10-cm increase) was associated with 18% (95% CI, 7.5%-30%) higher liver stiffness values after multivariable adjustment; waist circumference showed little association among HIV positive/HCV negative or HIV negative/HCV negative women. Among HIV positive/HCV negative women, history of AIDS (13%; 95% CI, 4% -27%) and HIV RNA (7.3%; 95% CI, 1.59%-13.3%, per 10-fold increase) were associated with greater liver stiffness.
  
  
  CONCLUSIONS
  HCV infection but not HIV infection is associated with greater liver stiffness when infected women are compared with those with neither infection. Our finding that waist circumference, a marker of central obesity, is associated with greater liver stiffness in HIV/HCV-coinfected but not HIV-monoinfected or women with neither infection suggests that in the absence of HCV-associated liver injury the adverse effects of obesity are lessened.
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: M Rami
authors.initials: MR
authors.lastname: Bailony
authors.forename: Rebecca
authors.initials: R
authors.lastname: Scherzer
authors.forename: Gregory
authors.initials: G
authors.lastname: Huhn
authors.forename: Michael W
authors.initials: MW
authors.lastname: Plankey
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
mesh_terms: D000328:Adult; D000367:Age Factors; D060085:Coinfection; D003710:Demography; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D016174:Hepacivirus / Q000502:physiology*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000821:virology; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012737:Sex Factors; D055105:Waist Circumference
keywords: HCV; HIV; liver fibrosis; obesity; transient elastography; women
references.citation: Hepatology. 2004 Mar;39(3):754-63
references.pmid: 14999694
references.citation: Hepatology. 2010 Aug;52(2):612-22
references.pmid: 20683959
references.citation: Clin Gastroenterol Hepatol. 2008 Jan;6(1):69-75
references.pmid: 18166478
references.citation: Arch Intern Med. 2006 Aug 14-28;166(15):1632-41
references.pmid: 16908797
references.citation: J Infect Dis. 2012 Mar 15;205(6):1005-13
references.pmid: 22291196
references.citation: Hepatology. 2001 Jun;33(6):1358-64
references.pmid: 11391523
references.citation: Am J Gastroenterol. 2004 Feb;99(2):292-8
references.pmid: 15046220
references.citation: Hepatology. 2005 Jul;42(1):63-71
references.pmid: 15892090
references.citation: Hepatology. 1999 Oct;30(4):1054-8
references.pmid: 10498659
references.citation: J Acquir Immune Defic Syndr. 2003 Mar 1;32(3):348-9
references.pmid: 12626899
references.citation: Aliment Pharmacol Ther. 2007 May 15;25(10):1181-91
references.pmid: 17451564
references.citation: J Hepatol. 2005 Jun;42(6):799-805
references.pmid: 15973779
references.citation: Gut. 2007 Jul;56(7):968-73
references.pmid: 17255218
references.citation: Clin Diagn Lab Immunol. 2005 Sep;12(9):1013-9
references.pmid: 16148165
references.citation: J Hepatol. 2009 Apr;50(4):797-804
references.pmid: 19231016
references.citation: Hepatology. 2005 Feb;41(2):372-9
references.pmid: 15723436
references.citation: J Clin Gastroenterol. 2010 Oct;44(9):637-45
references.pmid: 20844365
references.citation: Epidemiology. 1998 Mar;9(2):117-25
references.pmid: 9504278
references.citation: Clin Infect Dis. 2007 Oct 15;45(8):969-74
references.pmid: 17879910
references.citation: BMC Infect Dis. 2010 May 13;10:116
references.pmid: 20465840
references.citation: J Acquir Immune Defic Syndr. 2008 Jun 1;48(2):169-76
references.pmid: 18285711
references.citation: Clin Infect Dis. 2011 Mar 1;52(5):674-80
references.pmid: 21248367
references.citation: J Viral Hepat. 2012 Feb;19(2):e202-11
references.pmid: 22239520
references.citation: AIDS. 2006 Feb 28;20(4):525-31
references.pmid: 16470116
references.citation: Hepatology. 2003 Aug;38(2):518-26
references.pmid: 12883497
references.citation: Hepatology. 2006 Jun;43(6):1317-25
references.pmid: 16729309
references.citation: BMC Gastroenterol. 2012 Mar 27;12:27
references.pmid: 22453133
references.citation: Hepatology. 2009 Apr;49(4):1083-9
references.pmid: 19140221