Colleen Hadigan of Massachusetts General Hospital in Boston and colleagues conducted a study to evaluate liver steatosis in HIV positive men and women using non-invasive magnetic resonance spectroscopy (MRS), and to assess the relationship between liver fat content, insulin resistance, and other associated risk factors; results were reported in the November 1, 2007 Journal of Acquired Immune Deficiency Syndromes.

The study included 33 consecutive HIV positive adult patients (24 men; 9 women) who were not specifically referred for liver disease. The median age was 46 years, 55% were white, and 33% were black. About one-fifth were coinfected with HCV, and 1 had hepatitis B. Most (85%) were on stable antiretroviral therapy, and the median CD4 count was 441 cells/mm³. Individuals with end-stage liver disease, a history of excessive alcohol use within the past 3 years, or concurrent treatment for hepatitis C were excluded.

The main clinical measures were hepatic fat content measured by MRS, homeostasis model for assessment insulin resistance (HOMA-IR) scores, and body fat distribution assessed using cross-sectional computed tomography.

Results

• Liver steatosis (defined as hepatic fat content ≥ 5% of total organ weight) was identified in 14 study participants (42%).

• The average liver fat content was 14% (range 6% to 29%).

• Hepatic fat content was significantly correlated with HOMA-IR scores (P < 0.0001) and increased visceral fat (P < 0.001).

• Patients with steatosis had a significantly greater body mass index, higher alanine aminotransferase (ALT) and triglyceride levels, and increased intramuscular fat compared to subjects without steatosis.

• In contrast with some past studies, the presence of steatosis was not associated with duration of HIV infection, exposure to antiretroviral therapy, or HCV coinfection.

Conclusion

In conclusion, the authors wrote, “These data suggest that hepatic steatosis may be very common in HIV, not limited to those with HCV coinfection, and may play an important role in the metabolic profile among HIV-infected men and women.”

National Institutes of Health, National Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation, Bethesda, MD; Program in Nutritional Metabolism and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

12/14/07