medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2013, Number 5

<< Back Next >>

Ann Hepatol 2013; 12 (5)

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

Li Vecchi V, Giannitrapani L, Di Carlo P, Mazzola G, Colletti P, La Spada E, Vizzini G, Montalto G, Soresi M

Language: English
References: 54
Page: 740-748
PDF size: 131.16 Kb.


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.


REFERENCES

  1. Asselah T, Rubbia-Brandt L, Marcellin P, Negro F. Steatosis in chronic hepatitis C: why does it really matter? Gut 2006; 55: 123-30.

  2. Cua IH, Hui JM, Kench JG, George J. Genotype-specific interactions of insulin resistance, steatosis, and fibrosis in chronic hepatitis C. Hepatology 2008; 48: 723-31.

  3. Bedossa P, Moucari R, Chelbi E, Asselah T, Paradis V, Vidaud M, Cazals-Hatem D, et al. Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: a prospective study. Hepatology 2007; 46: 380-7.

  4. Machado MV, Oliveira AG, Cortez-Pinto H. Hepatic steatosis in patients co-infected with human immunodeficiency virus/hepatitis C virus: a meta-analysis of the risk factors. Hepatology 2010; 52: 71-8.

  5. Montalto G, Soresi M, Carroccio A, Bascone F, Tripi S, Aragona F, Di Gaetano G, et al. Percutaneous liver biopsy: a safe outpatient procedure? Digestion 2001; 63: 55-60.

  6. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993; 118: 96-8.

  7. Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991; 43: 26-31.

  8. Valls C, Iannacconne R, Alba E, Murakami T, Hori M, Passariello R, Vilgrain V. Fat in the liver: diagnosis and characterization. Eur Radiol 2006; 16: 2229-308.

  9. Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, Darriet M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005; 128: 343-50.

  10. de Lédinghen V, Douvin C, Kettaneh A, Ziol M, Roulot D, Marcellin P, Dhumeaux D, et al. Diagnosis of hepatic fibrosis and cirrhosis by transient elastography in HIV/hepatitis C virus-coinfected patients. J Acquir Immune Defic Syndr 2006; 41: 175-9.

  11. de Lédinghen V, Barreiro P, Foucher J, Labarga P, Castéra L, Vispo ME, Bernard PH, et al. Liver fibrosis on account of chronic hepatitis C is more severe in HIV-positive than HIV-negative patients despite antiretroviral therapy. J Viral Hepat 2008; 15: 427-33.

  12. Alberti KG, Zimmet P, Shaw J; IDF epidemiology task force consensus group. The metabolic syndrome-a new worldwide definition. Lancet 2005; 366: 1059-61.

  13. National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-421.

  14. Soares FM, Costa IM. HIV-Associated facial lipoatrophy: from the advent to current knowledge. An Bras Dermatol 2011; 86: 843-64.

  15. Sung KC, Ryan MC, King BS, Cho YK, Kim BI, Reaven GM. Relationship between estimates of adiposity, insulin resistance, and nonalcoholic fatty liver disease in a large group of non diabetic Korean adults. Diabetes Care 2007; 30: 2113-8.

  16. Saverymuttu SH, Joseph AEA, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. BMJ 1986; 292: 13-5.

  17. Li Vecchi V, Soresi M, Colomba C, Mazzola G, Colletti P, Mineo M, Di Carlo P, et al. Transient elastography: a non-in vasive tool for assessing liver fibrosis in HIV/HCV patients. World J Gastroenterol 2010; 16: 5225-32.

  18. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38: 518-26.

  19. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, Sulkowski M, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006; 43: 1317-25.

  20. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29-36.

  21. Schisterman EF, Perkins NJ, Liu A, Bondell H. Optimal cutpoint and its corresponding Youden index to discriminate individuals using pooled blood samples. Epidemiology 2005; 16: 73-81.

  22. Guaraldi G, Lonardo A, Ballestri S, Zona S, Stentarelli C, Orlando G, Carli F, et al. Human immunodeficiency virus is the major determinant of steatosis and hepatitis C virus of insulin resistance in virus-associated fatty liver disease. Arch Med Res 2011; 42: 690-7.

  23. Grunfeld C, Pang M, Doerrler W, Shigenaga JK, Jensen P, Feingold KR. Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metab 1992; 74: 1045-52.

  24. Grunfeld C, Kotler DP, Shigenaga JK, Doerrler W, Tierney A, Wang J, Pierson RN Jr., et al. Circulating interferon-alpha levels and hypertriglyceridemia in the acquired immunodeficiency syndrome. Am J Med 1991; 90: 154-62.

  25. Calza L, Manfredi R, Pocaterra D, Chiodo F. Risk of premature atherosclerosis and ischemic heart disease associated with HIV infection and antiretroviral therapy. J Infect 2008; 57: 16-32.

  26. Riddler SA, Smit E, Cole SR, Li R, Chmiel JS, Dobs A, Palella F, et al. Impact of HIV infection and HAART on serum lipids in men. JAMA 2003; 289: 2978-82.

  27. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413-9.

  28. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002 ; 123: 134-40.

  29. Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E, et al. Performance of transient elastography for the staging of liver fibrosis: a metaanalysis. Gastroenterology 2008; 134: 960-74.

  30. Sánchez-Conde M, Montes-Ramírez ML, Miralles P, Alvarez JM, Bellón JM, Ramírez M, Arribas JR et al. Comparison of transient elastography and liver biopsy for the assessment of liver fibrosis in HIV/hepatitis C virus-coinfected patients and correlation with noninvasive serum markers. J Viral Hepat 2010; 17: 280-6.

  31. Merchante N, Rivero-Juárez A, Téllez F, Merino D, Ríos-Villegas MJ, Márquez-Solero M, Omar M, et al. Liver stiffness predicts clinical outcome in HIV/HCV-coinfected patients with compensated liver cirrhosis. Hepatology 2012; 56: 228-38.

  32. Kim SU, Jang HW, Cheong JY, Kim JK, Lee MH, Kim DJ, Yang JM, et al. The usefulness of liver stiffness measurement using FibroScan in chronic hepatitis C in South Korea: a multicenter, prospective study. J Gastroenterol Hepatol 2011; 26: 171-8.

  33. Lupsor M, Badea R, Stefanescu H, Grigorescu M, Serban A, Radu C, Crisan D, et al. Performance of unidimensional transient elastography in staging non-alcoholic steatohepatitis. J Gastrointestin Liver Dis 2010; 19: 53-60.

  34. Operskalski EA, Kovacs A. HIV/HCV co-infection: pathogenesis, clinical complications, treatment, and new therapeutic technologies. Curr HIV/AIDS Rep 2011; 8: 12-22.

  35. Mohsen AH, Easterbrook PJ, Taylor C, Portmann B, Kulasegaram R, Murad S, Wiselka M, et al. Impact of human immunodeficiency virus (HIV) infection on the progression of liver fibrosis in hepatitis C virus infected patients. Gut 2003; 52: 1035-40.

  36. Thein HH, Yi Q, Dore GJ, Krahn MD. Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: a meta-analysis. AIDS 2008; 22: 1979-91.

  37. Macías J, Berenguer J, Japón MA, Girón JA, Rivero A, López- Cortés LF, Moreno A, et al. Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus. Hepatology 2009; 50: 1056-63.

  38. Sterling RK, Wegelin JA, Smith PG, Stravitz RT, Luketic VA, Fuchs M, Puri P, et al. Similar progression of fibrosis between HIV/HCV-infected and HCV-infected patients: Analysis of paired liver biopsy samples. Clin Gastroenterol Hepatol 2010; 8: 1070-6.

  39. Bruno R, Sacchi P, Cima S, Maiocchi L, Patruno SF, Klersy C, Barbarini G, et al. Correlation between FIB4, liver stiffness and metabolic parameters in patients with HIV and hepatitis C virus co-infection. Dig Liver Dis 2011; 43: 575-8.

  40. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, Fontaine H, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology 2007; 46: 32-6.

  41. Sterling RK, Smith PG, Brunt EM. hepatic steatosis in human immunodeficiency virus: a prospective study in patients without viral hepatitis, diabetes, or alcohol abuse. J Clin Gastroenterol 2012. Doi: 10.1097/ MCG.0b013e318264181d [Epub ahead of print].

  42. Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 2005; 42: 132-8.

  43. Blonsky JJ, Harrison SA. Review article: nonalcoholic fatty liver disease and hepatitis C virus-partners in crime. Aliment Pharmacol Ther 2008; 27: 855-65.

  44. Bugianesi E, Salamone F, Negro F. The interaction of metabolic factors with HCV infection: Does it matter? J Hepatol 2012; 56: 56-65.

  45. Leandro G, Mangia A, Hui J, Fabris P, Rubbia-Brandt L, Colloredo G, Adinolfi LE, et al. HCV Meta-Analysis (on) Individual Patients’ Data Study Group. Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data. Gastroenterology 2006; 130: 1636-42.

  46. van Wijk JP, Cabezas MC. Hypertriglyceridemia, metabolic syndrome, and cardiovascular disease in hiv-infected patients: effects of antiretroviral therapy and adipose tissue distribution. Int J Vasc Med 2012; 2012: 2010-27.

  47. Crum-Cianflone N, Dilay A, Collins G, Asher D, Campin R, Medina S, Goodman Z, et al. Nonalcoholic fatty liver disease among HIV-infected persons. J Acquir Immune Defic Syndr 2009; 50: 64-73.

  48. Negro F. Abnormalities of lipid metabolism in hepatitis C virus infection. Gut 2010; 59: 1279-87.

  49. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, Clark JM. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a metaanalysis. Hepatology 2011; 54: 1082-90.

  50. Soresi M, Giannitrapani L, Florena AM, La Spada E, Di Gesaro V, Rappa F, Alessandri A, et al. Reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia. Clin Radiol 2009; 64: 1181-7.

  51. Sánchez-Conde M, Montes Ramírez ML, Bellón Cano JM, Bellón Cano JM, Caminoa A, Rodríguez FA, Garcia JG, et al. Impact of liver steatosis on the correlation between liver stiffness and fibrosis measured by transient elastography in patients coinfected with human immunodeficiency virus and hepatitis C virus. J Viral Hepat 2011; 18: 278-83.

  52. Nguyen TA, Sanyal AJ. Pathophysiology guided treatment of nonalcoholic steatohepatitis. J Gastroenterol Hepatol 2012; 27: 58-64.

  53. Hickman IJ, Clouston AD, Macdonald GA, Purdie DM, Prins JB, Ash S, Jonsson JR, et al. Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C. Gut 2002; 51: 89-94.

  54. Nobili V, Carter-Kent C, Feldstein AE. The role of lifestyle changes in the management of chronic liver disease. BMC Med 2011; 9: 70.




2020     |     www.medigraphic.com