title: Human immunodeficiency virus-infected and uninfected adults with non-genotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection.
abstract: Hepatic steatosis (HS) is common in individuals with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, but the independent contributions of HCV and HIV to HS are unclear. Magnetic resonance imaging and spectroscopy were used to measure visceral adipose tissue (VAT) and liver fat fraction (LFF) (total lipids/[total lipids + water]) in 356 adults: 57 with HCV monoinfection, 70 with HIV/HCV coinfection, 122 with HIV monoinfection, and 107 with neither infection. Participants who were infected with HCV genotype 3 were excluded because of the genotype's reported steatogenic effects. For prevalence estimates, HS was defined as LFF ≥ 0.05. We estimated the association of HIV and HCV status with LFF using multivariable linear regression, adjusting for demographics, lifestyle, and metabolic factors including the homeostasis model assessment estimate of insulin resistance (HOMA-IR) and liver fibrosis defined using the aspartate aminotransferase-to-platelet ratio index (APRI). The prevalence of HS was highest in the uninfected (33%) and HIV-monoinfected (28%), followed by the HCV-monoinfected (19%) and HIV/HCV-coinfected (11%) (P = 0.003 across groups). Compared with uninfected participants-and after adjusting for demographics, lifestyle, and metabolic factors-HIV monoinfection, HCV monoinfection, and HIV/HCV coinfection were associated with 19% (95% confidence interval [CI], -39% to 6%), 38% (95% CI, -55% to -12%), and 42% (95% CI, -59% to -18%) lower LFF, respectively. HCV monoinfection and HIV/HCV coinfection remained strongly associated with lower LFF after further adjusting for APRI, and results were unchanged after excluding subjects with suspected cirrhosis. Among the entire cohort, Hispanic ethnicity, male sex, VAT, and HOMA-IR were independently associated with greater LFF.
  
  
  
  Contrary to expectations, HIV/HCV-coinfected and HCV-monoinfected adults had significantly less liver fat than uninfected adults, even after adjusting for demographics, lifestyle, metabolic factors, and hepatic fibrosis. Our findings suggest that non-genotype 3 HCV infection may be protective against HS. The mechanisms by which this occurs and the impact of HCV treatment on HS requires further investigation. (Hepatology 2017;65:853-863).
authors.affiliation: Department of Medicine, University of California, San Francisco, countryCode="US" CA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Price
authors.affiliation: Department of Medicine, University of California, San Francisco, countryCode="US" CA.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Medicine, University of California, San Francisco, countryCode="US" CA.|Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Scherzer
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Korn
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Tillinghast
authors.affiliation: Department of Medicine, University of California, San Francisco, countryCode="US" CA.
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Noworolski
authors.affiliation: Department of Medicine, University of California, San Francisco, countryCode="US" CA.|Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
mesh_terms: D060085:Coinfection / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005227:Fatty Acids / Q000378:metabolism*; D005234:Fatty Liver / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D005838:Genotype; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology* / Q000503:physiopathology; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D005227:Fatty Acids