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Analysis of the performance of non-invasive markers of steatosis and fibrosis in HIV-monoinfected patients at-risk of NAFLD: Results from the ERANET-HIVERA ECHAM study
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from Jules: It's been estimated 35% to 41% with HIV mono infection (without HCV or HBV) have NAFLD or NASH and liver fibrosis can accompany this diagnosis. In HIV+ many have elevated liver enzymes (ALT) but this does not get attention. Studies find years of use of old nucleosides are associated with this syndrome, as well HIV metabolic syndrome including lipodystrophy [http://www.natap.org/2002/Dec/120202_3.htm] and obesity & diabetes appear associated with this syndrome too. The main concern with Fatty liver is it can lead to advanced liver disease [http://www.natap.org/2016/AdverseReactComor/AdverseReactComor_35.htm]. Lifestyle change, including dietary habits and physical activity, are and should be the first line of treatment in NAFLD and NASH: weight reduction, exercise/physical activity Treatment of NAFLD with diet, physical activity and exercise. Recently fatty liver has been getting more attention with much new ongoing drug development, including with these studies at 2017 CROI & IAS and 2017 EASL liver conference - Fatty Liver in HIV+ at IAS - Current and Future Therapeutic Approaches to NAFLD/NASH - and here is a new section on the NATAP website devoted to Fatty Liver http://www.natap.org/liver.htm
Here is a study at EACS - in these HIV mono-infected patients, that is without HCV or HBV, with Metabolic Syndrome and/or persistently elevated ALT or GGT and/or lipodystrophy, liver biopsy done in 49 patients, this study found 23 (62%) had NASH, 48% (n-23) had steatosis (fatty liver) stage 2 or 3, 63% had liver fibrosis with 16% (n=8) with stage F3/F4, and 7 additional (14%) with F2. The authors conclude MRI is an "excellent" & Fibroscan is a "good" non-invasive test to diagnose steatosis (fatty liver) in this HIV mono infected "at-risk" population.
Reported by Jules Levin
16th European AIDS Conference, October 25-27, 2017. Milan
P. Ingiliz1, L. Assoumou2, S. De Wit3, P.-M. Girard4, M-A. Valantin5, A. Huefner6, H. Rougier4, S. Mauss7, L. Serfaty4, V. Ratziu5, Y. Menu4, J. Schlue9, G. Behrens9, P. Bedossa10, J. Capeau11, D. Costagliola2, M. Lemoine12
1ZIBP, Berlin, Germany, 2Sorbonne Universites, INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'epidemiologie et de Sante Publique, Paris, France 3Hopital Saint-Pierre, Bruxelles, Belgium, 4Hopital Saint-Antoine, Paris, France, 5Hopital Pitie-Salpetriere, Paris, France, 6University Hospital Hamburg-Eppendorf, Hamburg Germany, 7Center for HIV and Hepatogastroenterology, Düsseldorf, Germany, 8 9Hannover Medical School, Hannover, Germany, 10Beaujon Hospital, Paris, France , 11Inserm UMRS938, UPMC, Paris, 12Imperial College London, London, UK
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