Nearly one-third of patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are affected by hepatic steatosis (HS), according to study results published in AIDS Patient Care and STDs.1

Because of shared routes of transmission, HIV/HCV coinfection is common and is associated with more rapid progression toward severe liver disease compared with patients who are infected with HCV alone.2,3 In addition, HS appears to be more prevalent in patients coinfected with HIV/HCV than patients monoinfected with HCV.4 Thus, HIV-induced metabolic abnormalities and antiretroviral therapy (ART), genetic factors, as well as HCV coinfection may all cause HS.1  However, recent studies suggest a protective effect of HCV infection on HS as well as faster progression of HS and liver fibrosis in HIV-infected patients who are not coinfected with HCV.5,6 These discrepant data caused researchers to evaluate HS prior and after HCV eradication in an HIV/HCV-coinfected cohort of 247 patients at the Medical University of Vienna between January 2014 and June 2017. They found that HS was prevalent in 31% of patients, and that independent risk factors for HS were body mass index, year exposed to HIV, patatin like phospholipase domain containing 3 gene alleles, and protease inhibitor (PI) intake. They also observed a significant increase in controlled attenuation parameter (CAP) after HCV eradication, while patients on PI-containing ART experienced a significant decrease in CAP.

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The investigators concluded that, “Overall, one-third of HIV/HCV-coinfected patients are affected by HS with PI-based ART and [patatin like phospholipase domain containing 3 gene] PNPLA3 impacting on HS prevalence.”1 They added that, “future studies should account for metabolic syndrome and evaluate whether changes in CAP-based steatosis assessments correspond to a clinically relevant outcome.”


References
1. Chromy D, Mandorfer M, Bucsics T, et al. Prevalence and predictors of hepatic steatosis in patients with HIV/HCV coinfection and the impact of HCV eradication. AIDS Patient Care STDs. 2019;33(5):197-206.

1. Chromy D, Mandorfer M, Bucsics T, et al. Prevalence and predictors of hepatic steatosis in patients with HIV/HCV coinfection and the impact of HCV eradication. AIDS Patient Care STDs. 2019;33(5):197-206.

2. Alter MJ. Epidemiology of viral hepatitis and HIV coinfection. J Hepatol. 2006;44(1 suppl):S6-S9.

3. Mandorfer M, Schwabl P, Steiner S, Reiberger T, Peck-Radosavljevic M. Advances in the management of HIV/HCV coinfection. Hepatol Int. 2016;10:424-435.

4. Gaslightwala I, Bini EJ. Impact of human immunodeficiency virus infection on the prevalence and severity of steatosis in patients with chronic hepatitis C virus infection.
J Hepatol. 2006;44:1026-1032.

5. Pembroke T, Deschenes M, Lebouche B, et al. Hepatic steatosis progresses faster in HIV mono-infected than HIV/HCV co-infected patients and is associated with liverfibrosis. J Hepatol. 2017;67:801-808.

6. Price JC, Ma Y, Scherzer R, et al. Human immunodeficiency virus-infected and uninfected adults with nongenotype 3 hepatitis C virus have less hepatic steatosis than adults with neither infection. Hepatology. 2017;65:853-863.