Journal of hepatology 2017 05 17() pii 10.1016/j.jhep.2017.05.011
BACKGROUND & AIMS
Hepatic steatosis (HS) seems common in patients infected with human immunodeficiency virus (HIV). However, the relative effect of HIV, as well as hepatitis C virus (HCV) in those co-infected, and the influence of HS on liver fibrosis progression are unclear.
The LIVEr disease in HIV (LIVEHIV) is a Canadian prospective Cohort using transient elastography and associated controlled attenuation parameter (CAP) to screen for HS and liver fibrosis in unselected HIV-infected adults. HS progression was defined as development of any grade HS (CAP ≥248 dB/m), or transition to severe HS (CAP ≥292 dB/m) for those with any grade HS at baseline. Fibrosis progression was defined as development of significant liver fibrosis (liver stiffness measurement [LSM] ≥7.1kPa), or transition to cirrhosis (LSM ≥12.5kPa) for those with significant liver fibrosis at baseline. Cox regression analysis was used to assess predictors of HS and fibrosis progression.
A prospective cohort study was conducted, which included 726 HIV-infected patients (22.7% HCV co-infected). Prevalence of any grade HS did not differ between HIV mono-infected and HIV/HCV co-infected patients (36.1% vs 38.6%, respectively). 313 patients were followed for a median of 15.4 (interquartile range 8.5-23.0) months. The rate of HS progression was 37.8 (95% confidence interval [CI] 29.2-49.0) and 21.9 (95% CI 15.6-30.7) per 100 person-years in HIV mono-infection and HIV/HCV co-infection, respectively. HCV co-infection was an independent negative predictor of HS progression (adjusted hazard ratio [aHR] 0.50, 95% CI 0.28-0.89). HS predicted liver fibrosis progression in HIV mono-infection (aHR 4.18, 95% CI 1.21-14.5), but not in HIV/HCV co-infection.
HS progresses faster and is associated with liver fibrosis progression in HIV mono-infection but not in HIV/HCV co-infection.
Fatty liver is the most frequent liver disease in Western countries. People living with HIV seems at high risk for fatty liver due to frequent metabolic disorders and long-term effect of antiretroviral therapy. However, due to the invasiveness of liver biopsy, the traditional way to diagnose fatty liver, there are few data about its frequency in people living with HIV. In this work, we used a non-invasive diagnostic tool to study epidemiology of fatty liver in 726 HIV+ patients. We observed that fatty liver affects over one third of people living with HIV. When followed over time, we found that HIV+ patients without co-infection with HCV develops more frequently fatty liver than those co-infected with HCV.