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Abnormal lipids & GGT May Predict Poor Outcome in HCV/HIV Coinfection
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Abnormal Lipids (low cholesterol & triglycerides, high glucose) May Predict
Poor Outcome in HCV/HIV Coinfected
ICAAC Abstract title: "Hypolipidemia Impacts Mortality in Patients with HIV
and Hepatitis C (HCV) Co-infection". Abstract H-1723; C. HSIAO, J. MIQDADI;
University at Buffalo, SUNY, Buffalo, NY
Hypolipidemia (low levels of cholesterol & triglycerides) is frequently found
in severe chronic hepatic insufficiency because the liver is the most active
site of lipid metabolism. As well, diabetes is more prevalent in persons with
hepatitis C. The study authors say that a low baseline serum cholesterol
level may be associated with liver impairment and may be a sign of higher
mortality risk in patients with liver cirrhosis. One of the major causes of
mortality in HIV infected patients is liver related, especially, for those
who had HIV HCV co-infection. The cohort study is to see if hypolipidemia
impacts mortality in patients with HIV HCV co-infection. A retrospective
review was conducted of records of HIV infected patients during 12/98 until
9/01 in an urban HIV Clinic at Buffalo, New York. Statistical analyses were
performed using EpiInfo2000 and Prism 3.0 software to see if patient lipid
abnormalities impact risk of mortality. The entire study population is 640
patients. Of which 253 patients had HCV (median age: 43; 80 Females, 173 Men;
122 Black, 75 Hispanic, 52 white and 4 others). 41 deaths had occurred during
this study period with median time of 385 days (12-833 days) from the date of
data collection. Analyses of lipid pr files indicated that serum cholesterol
< 150 mg/dl, decreased VLDL, HDL level < 35 mg/dl or triglyceride level < 120
mg/dl were significantly associated with an increased risk of mortality with
Odd Ratios (ORs) of 2.79, 1.83 and 3.80 respectively. A higher total
cholesterol level (> 200 mg/dl) did not impact mortality; however, a higher
triglyceride level (> 320 mg/dl) reduced mortality (P = 0.047, OR: 0.31).
Hypotriglyceridemia is found to be the most weighted factor that correlates
mortality in HIV HCV co-infected patients; however, it does not impact
mortality in HIV-infected patients without HCV infection.
The authors concluded that hypolipidemia is a poor prognostic indicator for
patients with HIV HCV co-infection. According to previous literature,
hypolipidemia may be associated with patients poor nutritional status or
advanced stage of liver cirrhosis. In talking with the study authors he feels
that elevated glucose and low cholesterol and triglycerides may be a sign
that the liver is impaired and may be a sign of more advanced liver disease.
On the other hand, patients who undergo HCV therapy successfully be
eliminating HCV viral burden may see an increase in cholesterol &
triglycerides because the liver is functioned better. The authors suggest
that hypobetalipoproteinemia in patients with HCV suggests hepatic steatosis
and this can be a sign of advanced liver cirrhosis.
In a second study presented here by the same authors, they suggest that in
HCV/HIV coinfected patients with either serum glucose <120 mg/dL or
triglycerides <120 mg/dL with the combination of any other 2 factors or the
combination of any 4 factors can predict more than 50% risk for mortality
within 3 years (anemia <12 g/mL, HIV viral load >50,000 copies/ml, age >49,
platelets <130,000, LDH >700 U/L (1.25 times upper limit of normal).Also,
patients with hypolipidemia may be more susceptible to drug toxicity. Further
studies to explore the pathogenesis of hypolipidemia in patients with HIV HCV
co-infected patients are warranted.
GGT >100 Ul/ml Predicts More Advanced HCV
ICAAC Abstract title (H-1733): Features and Biochemical Markers of
Histological Severity in HIV-HCV Coinfected Patients
C. QUEREDA, L. MORENO, E. NAVAS, M. PEREZ-ELIAS, A. MORENO, S. DIZ, J.
CASADO, M. URIARTE, F. DRONDA, S. MORENO; RAMON Y CAJAL HOSPITAL, Madrid,
Spain
The purpose of this study was to assess potential biochemical markers of
histological severity (fibrosis and necroinflamatory activity) in HCV/HIV
coinfected patients. They did a prospective analysis of the histological
activity index (HAI) and fibrosis (F) in 99 liver biopsies (LB) from
HCV/HIV-coinfected, excluding chronic carriers of HBsAg. We evaluated factors
associated with HCV (genotype, VL, time of HCV, age at acquisition, sex), HIV
(CDC stage, CD4 and VL) and alcohol abuse. Mild-moderate hepatitis was
defined for HAI between 1-9, severe for HAI >10. Fibrosis > 10 was considered
severe. Most patients were male (77%), mean age 38 years (range 29-51). Prior
IVDU reported in 88%, and alcohol abuse in 30 (32%). Mean time of HCV
infection, 17 years (range, 3-34). Median CD4 and HIV-RNA at the time of LB
were 494 cells/µl (range, 36-1260) and 2.1 log10 (range, 1,7-5,4). HCV
genotype 1 was the most frequently observed (55%), and mean HCV-VL 2x106
UI/ml (range, 3x103-15x106). Hepatitis activity was mild in 29%, moderate in
58% and severe in 12% cases. LB showed a lack of fibrosis in 6%, F I in 38%,
F II in 18%, F III in 26%, and cirrhosis in 12%. By univariate analysis, a
GGT plasmatic level >100 UI/ml predicted a severe HAI (OR 6,9; 95% CI
[1,6-29,6], p=0,007). This was also confirmed by multivariate analysis
performed including potential confounding factors.
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