|Hepatic steatosis in human immunodeficiency virus: a prospective study in patients without viral hepatitis, diabetes, or alcohol abuse.|
|PMID: 23059409 Owner: NLM Status: MEDLINE|
|BACKGROUND AND AIMS: Abnormal liver enzymes (LEs) are common in those infected with human immunodeficiency virus (HIV). Histologic data on those with abnormal LE without viral hepatitis are lacking.
METHODS: HIV-positive subjects without hepatitis C virus, hepatitis B virus, alcohol abuse, and diabetes mellitus with more than 1 abnormal LE, defined as 1.25 ULN in aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase, over 6 months were included. Subjects underwent a 2-hour oral glucose tolerance test, fasting lipids, insulin and glucose for insulin resistance (IR) by homeostasis model assessment for insulin resistance (HOMA-IR) and dual-energy X-ray absorptiometry for fat distribution. Biopsies were read blindly to clinical data, and scored by Ishak histologic activity index for inflammation and fibrosis and NAFLD activity score.
RESULTS: Fourteen patients underwent biopsy. All were on highly active antiretroviral therapy with undetectable HIV RNA and mean CD4 614. The histologic activity index scores for inflammation and fibrosis were 3.43(1.4) and 1.71(1.26), respectively, and 2 patients had advanced fibrosis (bridging fibrosis/cirrhosis). The majority (65%) of patients had steatosis: grade 1: 21%, grade 2: 28%, and grade 3: 14%. Hepatocyte ballooning was seen in 7 (40%) but nonalcoholic steatohepatitis (NASH) was diagnosed only in 4 (26%). NAFLD activity score of all biopsies of 3.07 (2.2; range, 0 to 5). HOMA-IR was higher in those with compared with those without steatosis (3.52 vs. 1.91; P = 0.11) and highest in those with NASH (4.89). Using multivariate logistic regression, only increased γ-glutamyl transpeptidase (P = 0.0009) predicted steatosis whereas HOMA-IR (P = 0.0046) predicted NASH.
CONCLUSIONS: Although steatosis is common in HIV patients with abnormal LE without diabetes mellitus, alcohol, or viral hepatitis coinfection, NASH was observed in only 26%. The only clinical or laboratory feature associated with biopsy proven steatosis and NASH were γ-glutamyl transpeptidase and a calculated measure of insulin resistance, respectively. Further studies are needed in this population to determine the long-term clinical significance.
|Richard K Sterling; Paula G Smith; Elizabeth M Brunt|
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|Type: Journal Article; Research Support, N.I.H., Extramural|
|Title: Journal of clinical gastroenterology Volume: 47 ISSN: 1539-2031 ISO Abbreviation: J. Clin. Gastroenterol. Publication Date: 2013 Feb|
|Created Date: 2013-01-14 Completed Date: 2013-06-28 Revised Date: 2014-02-04|
Medline Journal Info:
|Nlm Unique ID: 7910017 Medline TA: J Clin Gastroenterol Country: United States|
|Languages: eng Pagination: 182-7 Citation Subset: IM|
|Data Bank Information|
Bank Name/Acc. No.:
|APA/MLA Format Download EndNote Download BibTex|
Alanine Transaminase / blood
Alkaline Phosphatase / blood
Antiretroviral Therapy, Highly Active
Aspartate Aminotransferases / blood
Biological Markers / blood
CD4 Lymphocyte Count
Clinical Enzyme Tests
Fatty Liver / diagnosis, etiology*
Glucose Tolerance Test
HIV / genetics, immunology
HIV Infections / complications*, diagnosis, drug therapy
Liver Cirrhosis / diagnosis, etiology
Predictive Value of Tests
RNA, Viral / blood
gamma-Glutamyltransferase / blood
|CCTR-UL1RR031990/RR/NCRR NIH HHS; R03 DK075416/DK/NIDDK NIH HHS; R03 DK075416/DK/NIDDK NIH HHS; UL1 TR000058/TR/NCATS NIH HHS|
|0/Biological Markers; 0/RNA, Viral; EC 126.96.36.199/gamma-Glutamyltransferase; EC 188.8.131.52/Aspartate Aminotransferases; EC 184.108.40.206/Alanine Transaminase; EC 220.127.116.11/Alkaline Phosphatase|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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