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Background:  Hepatic steatosis is associated with liver fibrosis progression in HIV-uninfected patients (pts) with chronic HCV infection.   The prevalence, severity and effects of steatosis are poorly understood in HIV/HCV co-infected pts.  We hypothesized that steatosis would be associated with more extensive liver fibrosis, host factors such as diabetes and obesity, and antiretroviral therapy (ART).

Methods:  Hepatic sections were assessed by a single pathologist for steatosis/steatohepatitis and hepatitis grade (0-4) and stage (0-4) in 48 HIV/HCV co-infected, HBsAg negative patients.  We retrospectively reviewed pt records to elucidate risk factors for steatosis.

Results:  Of 48 patients analyzed, 38% were female, 44% black, 29% Hispanic, and 27% white.  Median age was 43 yrs, median duration since HIV diagnosis was 9 years, and median CD4 was 418 cells/mL at time of biopsy:  46% had an AIDS diagnosis and 85% had history of ART;  65% were on ART at biopsy, including 35% on protease inhibitors (PI); and 29% on d4T.  Of patients with available HCV genotypes, 41 were 1a or b, 2 were 2a, and 1 was 3a (the type associated with steatosis in HIV-negative patients).   Of 45 patients with available HCV viral loads, 23 were >1,000,000 copies/mL.  Median BMI was 25.9 and similar in men and women; 17% of patients were diabetic.  Steatosis was present on 56% of biopsies, with grade 2-3 (of 3) in only 4%.  Steatosis was associated with degree of perisinusoidal fibrosis (p = 0.029) and bridging fibrosis (p = 0.029).  Overall fibrosis stage was generally more advanced in the steatosis group with a median stage of 2 compared to 1 in the group without steatosis (p = 0.063).  Inflammation was not associated with steatosis, though there was a higher median grade in pts with steatosis (2 vs 1-2,p = 0.087).  Steatosis was not associated with diabetes (odds ratio [OR] 1.36, 95% confidence interval [CI] 0.28 to 6.49, p= 0.70), alcohol use (OR 2.0, CI:  0.53 to 7.60 p = 0.31), BMI>25 (OR 2.05, CI: 0.62 to 6.75, p=0.24), antiretroviral use (OR=0.18, CI:  0.02 to 1.59, p = 0.12), duration of exposure to d4T (OR 1.01 per month, 95%CI:  0.97 to 1.04, p = 0.75) or PI (OR 1.00, 95%CI: 0.98 to 1.02, p = 0.99).

Conclusions: In HIV/HCV co-infected patients, hepatic steatosis is common and is associated with more advanced histological findings, including perisinusoidal and bridging fibrosis.  Duration of particular antiretroviral therapies was not associated with steatosis in this small study.

Keywords: Hepatitis C; Steatosis; Fibrosis