Journal Article

Hepatic Steatosis Is Associated with Fibrosis, Nucleoside Analogue Use, and Hepatitis C Virus Genotype 3 Infection in HIV-Seropositive Patients

Barbara H. McGovern, Jeremy S. Ditelberg, Lynn E. Taylor, Rajesh T. Gandhi, Katerina A. Christopoulos, Stacey Chapman, Beth Schwartzapfel, Emily Rindler, Anne-Marie Fiorino, M. Tauheed Zaman, Paul E. Sax, Fiona Graeme-Cook and Patricia L. Hibberd

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 43, issue 3, pages 365-372
Published in print August 2006 | ISSN: 1058-4838
Published online August 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/505495
Hepatic Steatosis Is Associated with Fibrosis, Nucleoside Analogue Use, and Hepatitis C Virus Genotype 3 Infection in HIV-Seropositive Patients

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Background. We conducted a study to determine the prevalence and factors associated with hepatic steatosis in human immunodeficiency virus (HIV)—seropositive patients with hepatitis C and to investigate whether steatosis is associated with liver fibrosis.

Methods. Retrospective chart reviews were conducted in 4 hospitals that serve community-based and incarcerated HIV-infected patients who had undergone a liver biopsy for evaluation of hepatitis C virus (HCV) infection during the period of 2000–2003. Demographic characteristics and medication and laboratory data were collected from the time of the biopsy. A pathologist blinded to all clinical data evaluated the specimens. The primary outcome was presence or absence of steatosis.

Results. of 260 HIV-HCV—coinfected patients, 183 met inclusion criteria and had a biopsy specimen adequate for review. Steatosis was present in 69% of patients (graded as minimal in 31%, mild in 27%, moderate in 18%, and severe in 1%). Factors associated with steatosis included use of dideoxynucleoside analogues, such as didanosine and stavudine (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.55–13.82). There was a trend toward presence of steatosis and use of other nucleoside analogues or infection with HCV genotype 3 (OR, 2.65 [95% CI, 0.95–7.41] and 3.38 [95% CI, 0.86–13.28], respectively). The presence of steatosis was associated with fibrosis (OR, 1.37; 95% CI, 1.03–1.81).

Conclusions. In this multiracial population of HIV-HCV—coinfected patients, steatosis was prevalent and was associated with severity of liver fibrosis. Use of nucleoside analogues (particularly didanosine and stavudine) and HCV genotype 3 infection were associated with hepatic steatosis. The development of steatosis is multifactorial in nature and may play a contributory role in the progression of liver disease in HIV-infected patients.

Journal Article.  5267 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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