Martinez Valrie, Ta Thi Dieu Ngan, Mokhtari Zahra, Guiguet Marguerite, Miailhes Patrick, Valantin Marc-Antoine, Charlotte Frderic, Bertheau Philippe, Molina Jean-Michel, Katlama Christine, Caumes Eric
Service de Mdecine Interne et Immunologie Clinique, Assistance Publique-Hpitaux de Paris, INSERM UMR_S 996, Universit Paris Sud, Hpital Antoine Bclre, 157 Rue de la Porte de Trivaux, 92141 Clamart, France.
BMC Res Notes. 2012 Jul 9;5:180. doi: 10.1186/1756-0500-5-180.
In HIV and hepatitis C virus (HCV) coinfected patients, the role of antiretroviral therapy (ART) on hepatic steatosis (HS) remains controversial.
HIV/HCV coinfected patients receiving ART and previously untreated for HCV who underwent a liver biopsy were included. Cumulative duration of exposure to each antiretroviral was recorded up to liver biopsy date. Logistic regression analyses evaluated factors associated with steatosis and its severity.
184 patients were included: median age 41 years, 84% male, 89% Caucasian, 61% with a past history of intravenous drug use. HCV genotypes were 1 (55%), 2 (6%), 3 (26%), and 4 (13%). Median HCV-RNA was 6.18 log10 IU/ml. HIV-RNA was undetectable (<400 copies/ml) in 67% of patients. Median CD4 count was 321/mm3. All patients had been exposed to nucleoside reverse transcriptase inhibitors (median cumulative exposure 56 months); 126 received protease inhibitors (23 months), and 79 non-nucleoside reverse transcriptase inhibitors (16 months). HS was observed in 102 patients (55%): 41% grade 1; 5% grade 2, and 9% grade 3. In multivariate analysis, HCV genotype 3 and HCV viral load were moderately associated with mild steatosis but strongly with grade 2-3 steatosis. After adjustment for the period of biopsy, no association was detected between HS and exposure to any antiretroviral class or drug, or duration of ART globally or comparing genotype 3 to others.
Among our ART-treated HIV-HCV cohort predominantly infected with genotype 1, 55% of patients had HS which was associated with HCV-related factors, but not ART class or duration of exposure.
在人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）合并感染的患者中，抗逆转录病毒疗法（ART）对肝脂肪变性（HS）的作用仍存在争议。
纳入接受ART治疗且既往未接受过HCV治疗并接受肝活检的HIV/HCV合并感染患者。记录直至肝活检日期时每种抗逆转录病毒药物的累积暴露时间。逻辑回归分析评估与脂肪变性及其严重程度相关的因素。
纳入184例患者：中位年龄41岁，84%为男性，89%为白种人，61%有静脉吸毒史。HCV基因型为1型（55%）、2型（6%）、3型（26%）和4型（13%）。HCV-RNA中位数为6.18 log10 IU/ml。67%的患者HIV-RNA检测不到（<400拷贝/ml）。CD4细胞计数中位数为321/mm³。所有患者均接触过核苷类逆转录酶抑制剂（中位累积暴露时间56个月）；126例接受蛋白酶抑制剂（23个月），79例接受非核苷类逆转录酶抑制剂（16个月）。102例患者（55%）出现HS：41%为1级；5%为2级，9%为3级。多因素分析中，HCV基因型3和HCV病毒载量与轻度脂肪变性中度相关，但与2 - 3级脂肪变性强烈相关。在对活检时间进行校正后，未发现HS与任何抗逆转录病毒药物类别或药物的暴露、ART的总体持续时间或基因型3与其他基因型之间存在关联。
在我们以ART治疗的主要感染1型基因型的HIV-HCV队列中，55%的患者有HS，这与HCV相关因素有关，而非ART药物类别或暴露持续时间。
