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Background:  The natural history of hepatic steatosis among HIV/hepatitis C virus (HCV) co-infected patients in the era of potent ART is unknown. We prospectively examined the change in steatosis grade between paired liver biopsies (bxs) among HIV/HCV co-infected patients attending an urban HIV clinic.

Methods:  We studied 57 co-infected individuals who had undergone 2 liver bxs. Paired bxs were simultaneously evaluated by a single pathologist who was blinded to bx sequence and scored:  grade 0, none; 1, fat involving < 5% of hepatocytes; 2, 5% to < 30%; 3, 30% to 60%; 4 > 60%. Clinical and laboratory data were collected from charts and the lab database. Alcohol assessment was computer-assisted. Logistic regression analysis was performed to determine correlates of steatosis change. Factors considered in analysis included demographics, alcohol, ART, liver enzymes over time, hepatic necroinflammatory activity, and fibrosis.   

Results:  Characteristics at or prior to the first bx were:  median age, 44 years; male, 70%; African American, 86%; median weight, 139 pounds, CD4 < 200/mm³, 18%; HIV RNA < 400 copies/mL, 60%; ART, 84%; alcohol abuse, 28%; persistently elevated ALT, 33%; hyperglycemia, 13%; hypertrigylceridemia, 26%; HCV genotype 1, 98%. Median time between bxs was 2.84 years (IQR, 2.04 to 3.41years). No steatosis change was observed in 33 patients (58%) whereas 1 grade increase occurred in 15 patients (26%) and ≥1 grade decrease occurred in 9 patients (16%). Compared to those with no change or decrease, patients with steatosis increase were more likely to have used stavudine within 2 years of the second bx (47% > 24%, p = 0.09). No significant association was detected between progression of steatosis and time between bxs, age, gender, alcohol use, ALT or glucose level, other ART use, HIV suppression, or CD4 cell count. Fibrosis progression between bxs was not associated with steatosis at first bx or change between bxs.

Conclusions:  Over a 3-year interval, no patient experienced a > 1 grade increase in steatosis, and the majority (74%) had stable or decreased steatosis. Furthermore, steatosis was not prospectively associated with progression of hepatic fibrosis. Finally, while we observed a trend toward worsening steatosis with recent D4T use, further research is required to determine the relationship of steatosis, ART, and metabolic disease.

Keywords: Steatosis ; HCV; Antiretroviral therapy