Non-invasive assessment of liver steatosis and fibrosis in HIV/HCV- and HCV- infected patients

Ann Hepatol. 2013 Sep-Oct;12(5):740-8.

Abstract

Background: Conflicting data have been reported on the prevalence of liver steatosis, its risk factors and its relationship with fibrosis in patients with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection or with HCV mono-infection.

Aim: The study aims were to assess steatosis prevalence and its risk factors in both HCV groups. We also evaluated whether steatosis was linked with advanced fibrosis. Sixty-eight HIV/HCV co-infected and 69 HCV mono-infected patients were consecutively enrolled. They underwent liver ultrasonography and transient elastography. Bright liver echo-pattern was used to diagnose steatosis; advanced fibrosis was defined as liver stiffness ≥ 9.5 kPa and FIB-4 values ≥ 3.25. The optimal stiffness cut-off according to FIB-4 ≥ 3.25 was evaluated by ROC analysis.

Results: No significant difference was found in steatosis-prevalence between mono- and co-infected patients (46.3 vs. 51.4%). Steatosis was associated with triglycerides and impaired fasting glucose/diabetes in HCV mono-infected, with lipodystrophy, metabolic syndrome, total-cholesterol and triglycerides in co-infected patients. Stiffness ≥ 9.5 was significantly more frequent in co-infection (P < 0.003). Advanced fibrosis wasn't significantly associated with steatosis. The area under the ROC curve was 0.85 (95% CI 0.79-0.9). On multivariate analysis steatosis was associated with triglycerides in both HCV mono- and co-infected groups (P < 0.02; P < 0.03).

Conclusion: Although steatosis was common in both HCV mono- and co-infected patients, it was not linked with advanced fibrosis. Triglycerides were independent predictors of steatosis in either of the HCV-groups. Dietary interventions and lifestyle changes should be proposed to prevent metabolic risk factors.

MeSH terms

  • Adult
  • Area Under Curve
  • Biomarkers / blood
  • Chi-Square Distribution
  • Coinfection*
  • Elasticity Imaging Techniques*
  • Fatty Liver / blood
  • Fatty Liver / diagnostic imaging*
  • Fatty Liver / ethnology
  • Fatty Liver / virology
  • Female
  • HIV Infections / blood
  • HIV Infections / complications*
  • HIV Infections / diagnosis
  • HIV Infections / ethnology
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / diagnosis
  • Hepatitis C, Chronic / ethnology*
  • Humans
  • Italy / epidemiology
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / ethnology
  • Liver Cirrhosis / virology
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prevalence
  • ROC Curve
  • Risk Factors
  • White People

Substances

  • Biomarkers