Liver Steatosis and its Effect on Hepatitis C Treatment in HIV-HCV Coinfected Individuals

Hepatic steatosis - fat accumulation in liver cells -- is caused by a complex interaction of host and viral factors such as metabolic syndrome, alcoholism, and genotype 3 hepatitis C virus (HCV), according to the authors of a study published in the February 7, 2008 advance online edition of the Journal of Hepatology.
Among HIV-HCV coinfected patients, antiretroviral therapy may also play a role.

The authors analyzed data from participants in APRICOT (the AIDS Pegasys Ribavirin International Coinfection Trial) who had paired liver biopsies interpreted and graded for steatosis along with lipid evaluations and body measurements.

APRICOT included 868 HCV-HIV coinfected patients in 19 countries who were randomly assigned to receive conventional interferon alpha plus 800 mg/day ribavirin, pegylated interferon alfa-2a (Pegasys) plus placebo, or pegylated interferon plus ribavirin for 48 weeks. As previously reported, the sustained virological response (SVR) rate was highest in the pegylated interferon plus ribavirin arm: 40% overall, 29% for patients with HCV genotype 1, and 62% for those with genotypes 2/3.

In the current analysis, the investigators looked at data from 283 APRICOT participants with available paired biopsy results. They assessed the prevalence of steatosis, baseline factors associated with steatosis, the effect of steatosis on efficacy of interferon-based therapy, and the impact of anti-HCV treatment on steatosis.

Results

• 65 of 283 patients (23%) with paired biopsies showed evidence of steatosis.

• Patients with steatosis were significantly more likely to have:
• HCV genotype 3 (versus other genotypes);
• Bridging fibrosis or cirrhosis;
• Higher HCV RNA levels;
• Increased triglyceride levels;
• Lower cholesterol levels.
•
The only difference in body measurements was neck circumference, which was greater in patients with steatosis and decreased significantly during treatment.

• Hip circumference at baseline was predictive of steatosis.

Conclusion

Based on these findings, the study authors concluded, "Factors associated [with] the metabolic syndrome are important in [HIV-HCV] coinfected patients."
They added that, "Treatment outcome affected steatosis in that viral eradication reduced steatosis in genotype 3 patients, but altogether steatosis did not affect efficacy of treatment in any genotype."

3/21/08

Reference
M Rodriguez-Torres, S Govindarajan, R Sola, and others. Hepatic steatosis in HCV/HIV co-infected patients: Correlates, efficacy and outcomes of anti-HCV therapy: A paired liver biopsy study. Journal of Hepatology. February 7, 2008 [Epub ahead of print].