Document Detail

Hepatic steatosis in human immunodeficiency virus: a prospective study in patients without viral hepatitis, diabetes, or alcohol abuse.
MedLine Citation:
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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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  47     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2013 Feb 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  182-7     Citation Subset:  IM    
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MeSH Terms
Absorptiometry, Photon
Alanine Transaminase / blood
Alkaline Phosphatase / blood
Antiretroviral Therapy, Highly Active
Aspartate Aminotransferases / blood
Biological Markers / blood
CD4 Lymphocyte Count
Chi-Square Distribution
Clinical Enzyme Tests
Cross-Sectional Studies
Fatty Liver / diagnosis,  etiology*
Glucose Tolerance Test
HIV / genetics,  immunology
HIV Infections / complications*,  diagnosis,  drug therapy
Insulin Resistance
Liver Cirrhosis / diagnosis,  etiology
Logistic Models
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prospective Studies
RNA, Viral / blood
Risk Factors
Time Factors
gamma-Glutamyltransferase / blood
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/RNA, Viral; EC; EC Aminotransferases; EC Transaminase; EC Phosphatase

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