By Liz Highleyman

Several previous studies have shown that liver disease related to hepatitis C virus (HCV) infection progresses more rapidly and may be more severe in individuals who also have HIV.

Hepatic steatosis (fatty liver) is a common finding in people with chronic hepatitis C; past studies have found prevalence rates of 30% to 70%, and it is particularly associated with HCV genotype 3.

A study reported in the June 2006 Journal of Hepatology adds to the evidence that steatosis is more common and more severe among HIV/HCV coinfected individuals.

In this prospective study, 708 consecutive patients undergoing liver biopsy were interviewed to obtain detailed demographic and clinical data; 154 of these subjects were HIV-positive. Steatosis was scored according to the percentage of hepatocytes involved: 0 (none), 1 (< 33%), 2 (33%-66%), or 3 (> 66%); liver fibrosis was scored on a scale of 0 to 4.

Results

Steatosis of any grade was significantly more common among HIV/HCV coinfected patients compared to those with HCV alone (72.1% vs 52.0%; P < 0.001) Grade 2 or 3 steatosis (48.1% vs 20.2%; P < 0.001) and stage 3 or 4 fibrosis (43.5% vs 30.0%; P = 0.002) were also seen significantly more often in the coinfected patients compared with the HCV monoinfected subjects. Among coinfected patients, the fibrosis progression rate rose in a linear fashion as the steatosis grade increased. Compared with HCV monoinfected subjects, HIV/HCV coinfection was associated with a significantly increased risk of steatosis of any grade (odds ratio = 3.21) and of grade 2 or 3 steatosis (odds ratio = 5.63) after adjusting for potential confounding variables.

Conclusion

The researchers concluded that "steatosis is more common and more severe in HIV/HCV coinfected patients than in those with HCV monoinfection."

As these researchers previously reported at the 2005 Digestive Disease Week conference, the microsteatosis pattern associated with mitochondrial damage was more frequently seen in HIV/HCV coinfected individuals. Hepatic steatosis with hepatomegaly (liver enlargement) is a rare but recognized adverse event associated with certain antiretroviral drugs, especially the combination of d4T (Zerit) plus ddI (Videx).

Further, it is increasingly recognized that steatosis is associated with elevated body mass index (BMI), insulin resistance, and the metabolic syndrome. Metabolic complications are a known side effect of some antiretroviral agents, in particular protease inhibitors, but it is not clear whether this helps account for the higher rate of steatosis in HIV/HCV coinfected patients.

In the February 28, 2006 issue of AIDS, French researchers reported that among 396 coinfected participants in the ANRS-HC02/Ribavic trial, 61% had some degree of steatosis (ranging from 38% with grade 1 to 7% with grade 3). HCV genotype 3, higher fibrosis score, higher BMI, and ferritin level all were significantly associated with development of steatosis. The risk factors for steatosis were found to be the same for HIV/HCV coinfected patients and HCV monoinfected individuals. HIV-related factors such as viral load, CD4 cell count, and type of antiretroviral therapy were not independently associated with steatosis.

6/09/06

References

I Gaslightwala and EJ Bini. Impact of human immunodeficiency virus infection on the prevalence and severity of steatosis in patients with chronic hepatitis C virus infection. Journal of Hepatology 44(6): 1026-1032. June 2006.

I Gaslightwala and others. Impact of HIV coinfection on the development of steatosis in patients with chronic hepatitis C virus infection. Abstract S1520. Digestive Disease Week. May 14-19, 2005. Chicago, Illinois.

F Bani-Sadr, F Carrat, P Bedossa, and others. Hepatic steatosis in HIV-HCV coinfected patients: analysis of risk factors. AIDS 20(4): 525-531. February 2006.

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