As reported in the January 7, 2008 issue of Hepatology,
researchers form Virginia Commonwealth University Health System reported on the
prevalence, risk factors, and features of steatosis and steatohepatitis (steatosis
plus liver inflammation) in coinfected
patients. The data were previously presented in part at the American Association
for the Study of Liver Diseases (AASLD) Annual Meeting in November 2007.
The
investigators prospectively reviewed liver biopsies for 222 consecutive coinfected
patients, looking at features of steatohepatitis including cytologic "ballooning"
and pericellular fibrosis. Three-quarters of the participants were men, the mean
age was 45 years, 78% were African American, and 90% had HCV genotype 1. The mean
body mass index (BMI) was 26 and 18% had a BMI greater than 30.
Results
•
23% of study participants demonstrated steatosis and 17% had steatohepatitis.
•
Steatosis was mild (5%-33%) in 19%, and moderate to severe (> 33%) in 4%.
•
Cytologic ballooning was present in 30%.
•
Pericellular fibrosis was present in 13%.
•
The mean Ishak fibrosis score was 6.9, and 33% had advanced bridging fibrosis
or cirrhosis.
•
Both steatosis and cytologic ballooning were associated with higher BMI, metabolic
syndrome, and insulin resistance.
•
The presence of either was strongly associated with advanced fibrosis (P <
0.0001).
•
The prevalence of risk factors for steatosis were:
•
Diabetes was associated with cytologic ballooning.
•
Longer duration of HCV infection was associated with steatohepatitis.
Conclusion
The
researchers concluded that, "Steatosis and steatohepatitis are present in
23% and 30%, respectively, of patients with HIV-HCV coinfection, and both are
associated with an increased risk of having advanced fibrosis." This compares
with other studies that have observed higher rates of steatosis in confected people
- up to 75%.
"Although we did identify genotype 3, increased BMI,
and diabetes as risk factors," they added, "we found no independent
association with antiretroviral therapy." This is reassuring, since some
anti-HIV drugs have been linked to liver toxicity, primarily ddI, d4T, and nevirapine.
4/01/08
Reference RK
Sterling, MJ Contos, PG Smith, and others. Steatohepatitis: Risk factors and impact
on disease severity in human immunodeficiency virus/hepatitis C virus coinfection.
Hepatology 47(4): 1118-1127. January 7, 2008.
Results
