HIV
and Hepatitis.com Coverage of the 14th
Annual Conference on Retroviruses and Opportunistic Infections (14th CROI) February
25 - 28, 2007, Los Angeles, CA
Hepatic
Steatosis and Liver Function Test Abnormalities in People with HIV
Non-alcoholic
fatty liver disease (NAFLD) and steatohepatitis (NASH) are increasingly prevalent
in the general population, coinciding with a growing epidemic of obesity. HIV
positive individuals are at increased risk for liver disease associated with drug-related
hepatotoxicity and hepatitis B or C coinfection, but there is little data on fatty
liver disease among HIV-infected patients without hepatitis C virus (HCV) infection.
As
described in a poster at the 14th Conference on Retroviruses and Opportunistic
Infections last month in Los Angeles, researchers studied 200 patients from a
military HIV clinic with a low rate of HCV coinfection to examine the prevalence
and predictors of steatosis and abnormal liver function tests (LFTs). The mean
age was 39 years, 94% were men, 50% were Caucasian, 25% were African-American,
the mean CD4 cell count was about 550 cells/mm3, and three-quarters had received
HAART.
Participants completed questionnaires about medication use and
behavior and received liver function tests and liver ultrasound scans. Those with
abnormal LFTs received additional laboratory tests, and those with liver disease
of unknown cause underwent liver biopsies. Results
•
Of the 200 patients, 30% had abnormal LFTs, most of which were grade 1.
•
Among patients with
elevated LFTs:
- 7 (12%) were hepatitis B surface antigen (HbsAg) positive; -
2 (3%) were HCV seropositive; - 1 patient had probable hemochromatosis (iron
overload disease).
•
There was no difference
in symptoms (e.g., nausea, abdominal pain, loss of appetite, fatigue) between
patients with and without abnormal LFTs.
•
Ultrasound scans (n
= 148) showed that about 30% of patients had steatosis:
- mild: 15% with
abnormal LFTs vs 19% with normal LFTs; - moderate: 13% with abnormal LFTs vs
8 with normal LFTs; - severe or marked: none with abnormal LFTs vs 2% with
normal LFTs.
•
Of these, 93% met the
criteria for NAFLD.
•
Biopsies revealed that
25% of patients had liver fibrosis.
•
22% of patients with
steatosis had abnormal liver function tests, and 90% had hepatomegaly (enlarged
liver).
•
In a multivariate
model, the following factors predicted abnormal liver function tests:
-
past or current HAART use; - alcohol use; - increased body mass index (BMI).
•
The following factors
predicted liver steatosis:
- increased BMI; - d4T (Zerit) use (borderline
significance).
Conclusion
"Non-alcoholic hepatic steatosis is common (~30%) among HIV-infected
patients," the researchers concluded. "Risk factors for NAFLD among
HIV patients include increased BMI and/or waist circumference and perhaps d4T."
"Hepatomegaly,
but not abnormal liver function tests, was predictive of non-alcoholic fatty liver
disease," they added. "Liver function tests are not a useful screening
test for steatosis."
Naval
Med Ctr, San Diego, CA; TriService AIDS Clinical Consortium, Lackland AFB, TX.
Reference Nancy
Crum-Cianflone, C Hames, S Medina, and other (TriService AIDS Clinical Consortium).
Hepatic Steatosis and Liver Function Abnormalities among HIV-infected Persons.
14th Conference on Retroviruses and Opportunistic Infections; February 25-28,
2007; Los Angeles, California. Abstract 822 (poster).
