Keith Alcorn September 11, 2019
People with HIV and hepatitis C coinfection who had fatty liver disease were twice as likely to die during a five-year follow-up period as their counterparts without fatty liver disease, French researchers report in Hepatology.
Researchers say using noninvasive measures of fatty liver disease can help doctors identify patients at highest risk of death and urge research into other cohorts of people with HIV and hepatitis C to validate the fatty liver index.
Fat accumulation in liver cells (fatty liver) is caused by metabolic disorders, insulin resistance, and systemic inflammation. Hepatitis C causes insulin resistance, and both hepatitis C and HIV cause inflammation.
Hepatitis steatosis can progress to non-alcoholic steatohepatitis (NASH), inflammation of the liver resulting from fat buildup. In some people, NASH will lead to the development of more severe liver damage: fibrosis, cirrhosis, or liver cancer (hepatocellular carcinoma).
The severity of fat accumulation can be estimated using laboratory measurements and body mass measurements in an algorithm called the Fatty Liver Index. The Fatty Liver Index is calculated using body mass index, waist circumference, triglycerides, and gamma glutamyl transferase (GGT). A score below 30 rules out fatty liver disease, and a score above 60 confirms fatty liver disease.
The fatty liver index has been shown to predict liver-related and all-cause mortality in the general population but has not been evaluated in people with HIV and hepatitis C co-infection. French researchers investigated the relationship between hepatic steatosis and mortality in the HEPAVIH cohort, a prospective national cohort of people with HIV and hepatitis C.
The study examined 983 people recruited into the cohort between 2005 and 2008 who had provided detailed behavioural data on alcohol and coffee consumption, smoking, mental health, housing and employment status and who were followed for at least five years or until death.
The study population was 70% male and had a median age of 49 years. Eighty-eight percent had CD4 counts greater than 200 cells/mm3 and 89% were taking antiretroviral therapy at the start of the follow-up period. Advanced fibrosis (FIB-4 score >3.25) was rare; only 15% had fibrosis and only 12% had received treatment for hepatitis C and were cured at the time of joining the study.
A high fatty liver index may be a marker of metabolic disorders and cardiovascular risk.
Twenty-seven percent of the cohort had hepatic steatosis at baseline, 12% had a fatty liver index measurement above 60 at all study visits, and 31% had a fatty liver index measurement above and below 60 during follow-up.
People with a fatty liver index score of 60 or higher had significantly higher body mass index, triglycerides, and waist circumference and were also more likely to be male, older than 50 years, have advanced fibrosis (23%), have a history of hepatocellular carcinoma or liver transplant, or have clinical signs of cirrhosis such as ascites or bleeding from esophageal varices at enrollment. They were less likely to smoke, more likely to abstain from alcohol, and more likely to drink two cups of coffee or less each day.
There were no differences between people with a high fatty liver score and those without employment, housing status, hepatitis C virus (HCV) genotype, HCV treatment status, HIV transmission category, HIV disease stage, antiretroviral treatment, CD4 cell count, mental health status, or heavy alcohol use.
Sixty-three people died during the follow-up period, 40% due to hepatitis C, 3% due to non-AIDS-related cancers, 11% from AIDS-related illnesses, and 5% due to cardiovascular diseases.
People with a fatty liver score greater than 60 at baseline were twice as likely to die during the follow-up period (hazard ratio 1.91, 95% CI 1.17-3.32, p = 0.009) after controlling for other risk factors.
People with a history of hepatocellular carcinoma or liver transplant at baseline were seven times more likely to die during the follow-up period, regardless of fatty liver index status.
Advanced fibrosis or signs of cirrhosis at baseline also increased the risk of death, as did symptomatic HIV disease (CDC stage C).
The researchers say theirs is the first study to show that elevated fatty liver disease is associated with an increased risk of death, independent of other risk factors, in people with HIV and hepatitis C coinfection.
An elevated fatty liver index may be a marker for metabolic disorders and cardiovascular risk, the researchers say. Future research should attempt to collect more data on insulin resistance to clarify the mechanisms involved in the association between an elevated fatty liver index and mortality.
Referencias
Barré T et al. Elevated fatty liver index as a risk factor for all-cause mortality in HIV-HCV co-infected patients (ANRS CO13 HEPAVIH cohort study). Hepatology, advance online publication, August 29, 2019, https://doi.org/10.1002/hep.30914
At: http://www.aidsmap.com/news/sep-2019/fatty-liver-raises-risk-death-people-hiv-and-hepatitis-c