Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.
Hepatology. 2012 Oct;56(4):1261-70. doi: 10.1002/hep.25791. Epub 2012 Sep 11.
Hepatic steatosis (HS) is frequent in human immunodeficiency virus (HIV)- and hepatitis C virus (HCV)-coinfected patients. Antiretroviral therapy (ART) and metabolic alterations could induce HS. However, a protective effect of ART has been reported in a paired biopsy study. Thus, our aim was to examine the changes and predictors of HS progression among HIV/HCV-coinfected patients with sequential biopsies. We also evaluated the rates of steatohepatitis and factors associated thereof. HIV-infected patients with detectable serum HCV RNA, who underwent two biopsies, separated at least by 1 year, were included in this retrospective study. HS progression was defined as increase in one or more HS grades. The median (interquartile range) time between biopsies was 3.3 (2.0-5.2) years. Among 146 individuals, HS at baseline was observed in 86 (60%) patients and in 113 (77%) in the follow-up biopsy (P < 0.001). Progression of HS was observed in 60 (40%) patients. HS regressed in 11 (8%) patients. Factors associated with HS progression were changes in fasting plasma glucose (FPG) between biopsies (per 10 mg/dL increase; odds ratio [OR] [95% confidence interval; CI] = 1.4 [1.04-1.8]; P = 0.024) and cumulative use of dideoxynucleoside analogs (per year; OR [95% CI] = 1.5 [1.2-1.8]; P = 0.001). Persistent steatohepatitis or progression to steatohepatitis between biopsies was observed in 27 (18%) patients. Persistence of or progression to steatohepatitis was associated with progression ≥ 1 fibrosis stages between biopsies (OR [95% CI] = 2.4 [1.01-5.7]; P = 0.047).
HS progresses frequently and regression is rarely observed in HIV/HCV-coinfected patients, including in those on ART. Cumulative exposure to dideoxynucleoside analogs and increases in FPG are related with HS progression. Stetatohepatitis is frequently observed in these patients and is linked to fibrosis progression.
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，肝脂肪变性（HS）很常见。抗逆转录病毒治疗（ART）和代谢改变可诱导 HS。然而，配对活检研究报告 ART 具有保护作用。因此，我们的目的是检查 HIV/HCV 合并感染患者连续活检中 HS 进展的变化和预测因素。我们还评估了脂肪性肝炎的发生率及其相关因素。
这项回顾性研究纳入了血清 HCV RNA 可检测、至少相隔 1 年接受两次活检的 HIV 感染患者。将 HS 进展定义为一个或多个 HS 分级增加。两次活检之间的中位数（四分位间距）时间为 3.3（2.0-5.2）年。在 146 名患者中，基线时 HS 见于 86 名（60%）患者，随访活检中 HS 见于 113 名（77%）患者（P < 0.001）。60 名（40%）患者的 HS 进展。11 名（8%）患者的 HS 消退。与 HS 进展相关的因素包括活检之间空腹血糖（FPG）的变化（每增加 10mg/dL；比值比[OR] [95%置信区间；CI] = 1.4 [1.04-1.8]；P = 0.024）和叠氮胸苷类似物的累积使用（每年；OR [95%CI] = 1.5 [1.2-1.8]；P = 0.001）。在 27 名（18%）患者中观察到活检之间持续性脂肪性肝炎或进展为脂肪性肝炎。活检之间纤维化分期进展≥1期与持续性或进展为脂肪性肝炎相关（OR [95%CI] = 2.4 [1.01-5.7]；P = 0.047）。
HIV/HCV 合并感染患者的 HS 常进展，很少出现消退，包括接受 ART 的患者。叠氮胸苷类似物的累积暴露和 FPG 的增加与 HS 进展相关。这些患者中脂肪性肝炎常发生，并与纤维化进展相关。
