Prospective evaluation of hepatic steatosis in HIV-infected patients with orwithout hepatitis C virus co-infection

Background: Limited data are available on hepatic steatosis (HS) in HIV patients who are not infectedwith hepatitis C virus (HCV). The aims of this study were to assess the prevalence of HS and its risk factorsin HIV patients with and without HCV infection, and to evaluate whether HS correlates with advancedliver fibrosis and/or cardiovascular disease risk.Methods: Fifty-seven HIV mono-infected and 61 HIV/HCV co-infected patients were enrolledconsecutively. All patients underwent liver ultrasound and transient elastography. The main parametersof liver function, HIV and HCV viral loads, CD4+ cell counts, and data on highly active antiretroviraltherapy (HAART) were recorded. Cardiovascular disease risk was evaluated using the 10-yearFramingham risk score.Results: HS prevalence in the whole HIV population was 53% (54% in mono-infected patients and 51% inco-infected patients). HS was associated with lipodystrophy and triglyceride values (p < 0.0001),metabolic syndrome (p < 0.0004), and total cholesterol levels (p < 0.001) in both HIV groups. In HIVmono-infected patients, HS was linked with HAART exposure of >1 year (p < 0.01). By multivariateanalysis, only triglyceride levels (p < 0.02) and Framingham risk score (p < 0.05) were independentlyassociated with HS in both HIV groups. No correlation was observed between HS and advanced liverfibrosis, measured by transient elastography.Conclusions: HS was common in HIV patients, occurring in about half of the population. HS was found tobe linked with the Framingham risk score, but was not correlated with advanced liver fibrosis. Wesuggest that in our HIV population with HS, the burden of cardiovascular disease risk is greater than thatof liver disease progression.