Bani-Sadr Firouzé, Carrat Fabrice, Bedossa Pierre, Piroth Lionel, Cacoub Patrice, Perronne Christian, Degott Claude, Pol Stanislas
Groupe Hospitalier Universitaire Est, Université Paris 6, INSERM V707, Paris, France.
AIDS. 2006 Feb 28;20(4):525-31. doi: 10.1097/01.aids.0000210606.63138.f5.
To evaluate the prevalence and severity of steatosis and possible interactions between steatosis, host factors, viral factors, and treatment for HIV infection in HIV-hepatitis C virus (HCV) coinfected patients.
Steatosis was assessed among 395 HIV-HCV coinfected patients who were enrolled in the ANRS trial HC02 Ribavic and for whom histological data were available. Steatosis was graded as follows: 0 (none); 1 (< 30% hepatocytes containing fat); 2 (30-70%); 3 (> 70%).
Steatosis was present in 241 patients (61%), of whom 149 (38%) had grade 1, 64 (16%) grade 2 and 28 (7%) grade 3. In multivariate analysis, the following five independent risk factors were associated with steatosis: HCV genotype 3 [odds ratio (OR), 3.02; 95% confidence interval (CI), 1.91-4.79; P < 0.0001], the mean METAVIR fibrosis score (OR, 1.43; 95% CI, 1.11-1.84; P = 0.0053), the body mass index (BMI; OR, 1.13; 95% CI, 1.05-1.21; P = 0.0013), HCV viral load (OR. 1.65; 95% CI, 1.22-2.23; P = 0.0012) and ferritin (OR, 1.13; 95% CI, 1.06-1.21; P < 0.0003). As HCV genotype 3 was a risk factor for steatosis, further exploratory analyses were stratified according to the HCV genotype (1 and 3). Factors independently associated with steatosis were BMI and HCV viral load in patients with HCV genotype 3 infection and the mean METAVIR fibrosis score, the BMI and ferritin in patients with HCV genotype 1 infection.
Steatosis is particularly frequent in HIV-HCV coinfected patients, who appear to have the same risk factors for steatosis as HCV monoinfected patients. None of the characteristics of HIV infection, including antiretroviral therapy, was independently associated with steatosis.
评估人类免疫缺陷病毒（HIV）与丙型肝炎病毒（HCV）合并感染患者中脂肪变性的患病率和严重程度，以及脂肪变性、宿主因素、病毒因素和HIV感染治疗之间可能的相互作用。
对395例参与法国国家艾滋病研究机构（ANRS）HC02利巴韦林试验且有组织学数据的HIV-HCV合并感染患者进行脂肪变性评估。脂肪变性分级如下：0级（无）；1级（<30%的肝细胞含脂肪）；2级（30%-70%）；3级（>70%）。
241例患者（61%）存在脂肪变性，其中149例（38%）为1级，64例（16%）为2级，28例（7%）为3级。多因素分析显示，以下五个独立危险因素与脂肪变性相关：HCV基因3型[比值比（OR），3.02；95%置信区间（CI），1.91-4.79；P<0.0001]、METAVIR纤维化平均评分（OR，1.43；95%CI，1.11-1.84；P=0.0053）、体重指数（BMI；OR，1.13；95%CI，1.05-1.21；P=0.0013）、HCV病毒载量（OR，1.65；95%CI，1.22-2.23；P=0.0012）和铁蛋白（OR，1.13；95%CI，1.06-1.21；P<0.0003）。由于HCV基因3型是脂肪变性的危险因素，因此根据HCV基因型（1型和3型）进行了进一步的探索性分析。与脂肪变性独立相关的因素在HCV基因3型感染患者中为BMI和HCV病毒载量，在HCV基因1型感染患者中为METAVIR纤维化平均评分、BMI和铁蛋白。
脂肪变性在HIV-HCV合并感染患者中尤为常见，这些患者似乎与HCV单一感染患者具有相同的脂肪变性危险因素。HIV感染的任何特征，包括抗逆转录病毒治疗，均与脂肪变性无独立关联。
