Return-to-health effect of modern combined antiretroviral therapy potentially predisposes HIV patients to hepatic steatosis

Raphael Mohr, Christoph Boesecke, Leona Dold, Robert Schierwagen, Carolynne Schwarze-Zander, Jan-Christian Wasmuth, Insa Weisensee, Jürgen Kurt Rockstroh, Jonel Trebicka

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Resumé

Prevalence and risk factors for hepatic steatosis (HS) in the human immunodeficiency virus (HIV)-positive population of western countries are controversially discussed and potentially confounded by coinfection with viral hepatitis. Significant HS (more than 10% of hepatocytes) can be accurately assessed using controlled attenuation parameter (CAP) determination. Aim of this study was to assess prevalence and factors associated with significant HS in HIV monoinfected patients.A total of 364 HIV-infected patients (289 monoinfected) were included in this prospective, cross-sectional study. All patients underwent CAP determination. Steatosis was classified as S1 (significant steatosis) with CAP > 238 dB/m, S2 with CAP > 260 dB/m, and S3 with CAP > 292 dB/m. Multivariable logistic regression analyses were performed to assess the factors associated with HS in this cohort.Significant HS was detected in 118 monoinfected patients (149 in the total cohort). In the total cohort as well as in the monoinfected patients alone, HS grade distribution showed a similar pattern (S1:29%, S2:34%, and S3:37%). Interestingly, patients with HS had a longer history of HIV infection and combined antiretroviral therapy (cART). Interalia, age, gender, ethnicity, and metabolic factors were strongly associated with HS, while body mass index (BMI), triglyceride, and glycated hemoglobin (HbA1c) levels were independently associated with significant HS.HS is highly prevalent among HIV monoinfected patients. Although metabolic risk factors, such as obesity and poorly controlled diabetes, are independently associated with HS in HIV monoinfected patients, cART and control of HIV seem to play an indirect role in the development of HS, probably through the return-to-health effect.

OriginalsprogEngelsk
Artikelnummere0462
TidsskriftMedicine
Vol/bind97
Udgave nummer17
Antal sider7
ISSN0025-7974
DOI
StatusUdgivet - 1. apr. 2018

Fingeraftryk

HIV
Liver
Health
Glycosylated Hemoglobin A
Virus Diseases
Coinfection
Hepatitis
Hepatocytes
Body Mass Index
Cross-Sectional Studies
Logistic Models
Regression Analysis
Population

Citer dette

Mohr, Raphael ; Boesecke, Christoph ; Dold, Leona ; Schierwagen, Robert ; Schwarze-Zander, Carolynne ; Wasmuth, Jan-Christian ; Weisensee, Insa ; Rockstroh, Jürgen Kurt ; Trebicka, Jonel. / Return-to-health effect of modern combined antiretroviral therapy potentially predisposes HIV patients to hepatic steatosis. I: Medicine. 2018 ; Bind 97, Nr. 17.
@article{5a04161b79454e8b883f00d4a8fb7f10,
title = "Return-to-health effect of modern combined antiretroviral therapy potentially predisposes HIV patients to hepatic steatosis",
abstract = "Prevalence and risk factors for hepatic steatosis (HS) in the human immunodeficiency virus (HIV)-positive population of western countries are controversially discussed and potentially confounded by coinfection with viral hepatitis. Significant HS (more than 10{\%} of hepatocytes) can be accurately assessed using controlled attenuation parameter (CAP) determination. Aim of this study was to assess prevalence and factors associated with significant HS in HIV monoinfected patients.A total of 364 HIV-infected patients (289 monoinfected) were included in this prospective, cross-sectional study. All patients underwent CAP determination. Steatosis was classified as S1 (significant steatosis) with CAP > 238 dB/m, S2 with CAP > 260 dB/m, and S3 with CAP > 292 dB/m. Multivariable logistic regression analyses were performed to assess the factors associated with HS in this cohort.Significant HS was detected in 118 monoinfected patients (149 in the total cohort). In the total cohort as well as in the monoinfected patients alone, HS grade distribution showed a similar pattern (S1:29{\%}, S2:34{\%}, and S3:37{\%}). Interestingly, patients with HS had a longer history of HIV infection and combined antiretroviral therapy (cART). Interalia, age, gender, ethnicity, and metabolic factors were strongly associated with HS, while body mass index (BMI), triglyceride, and glycated hemoglobin (HbA1c) levels were independently associated with significant HS.HS is highly prevalent among HIV monoinfected patients. Although metabolic risk factors, such as obesity and poorly controlled diabetes, are independently associated with HS in HIV monoinfected patients, cART and control of HIV seem to play an indirect role in the development of HS, probably through the return-to-health effect.",
keywords = "Adult, Age Factors, Aged, Anti-Retroviral Agents/therapeutic use, Body Mass Index, Comorbidity, Cross-Sectional Studies, Drug Therapy, Combination, Fatty Liver/epidemiology, Female, HIV Infections/drug therapy, Humans, Logistic Models, Male, Middle Aged, Prospective Studies, Risk Factors, Severity of Illness Index, Sex Factors, Young Adult, liver injury, NAFLD, HIV monoinfection, cART, CAP",
author = "Raphael Mohr and Christoph Boesecke and Leona Dold and Robert Schierwagen and Carolynne Schwarze-Zander and Jan-Christian Wasmuth and Insa Weisensee and Rockstroh, {J{\"u}rgen Kurt} and Jonel Trebicka",
year = "2018",
month = "4",
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doi = "10.1097/MD.0000000000010462",
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Mohr, R, Boesecke, C, Dold, L, Schierwagen, R, Schwarze-Zander, C, Wasmuth, J-C, Weisensee, I, Rockstroh, JK & Trebicka, J 2018, 'Return-to-health effect of modern combined antiretroviral therapy potentially predisposes HIV patients to hepatic steatosis', Medicine, bind 97, nr. 17, e0462. https://doi.org/10.1097/MD.0000000000010462

Return-to-health effect of modern combined antiretroviral therapy potentially predisposes HIV patients to hepatic steatosis. / Mohr, Raphael; Boesecke, Christoph; Dold, Leona; Schierwagen, Robert; Schwarze-Zander, Carolynne; Wasmuth, Jan-Christian; Weisensee, Insa; Rockstroh, Jürgen Kurt; Trebicka, Jonel.

I: Medicine, Bind 97, Nr. 17, e0462, 01.04.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Return-to-health effect of modern combined antiretroviral therapy potentially predisposes HIV patients to hepatic steatosis

AU - Mohr, Raphael

AU - Boesecke, Christoph

AU - Dold, Leona

AU - Schierwagen, Robert

AU - Schwarze-Zander, Carolynne

AU - Wasmuth, Jan-Christian

AU - Weisensee, Insa

AU - Rockstroh, Jürgen Kurt

AU - Trebicka, Jonel

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Prevalence and risk factors for hepatic steatosis (HS) in the human immunodeficiency virus (HIV)-positive population of western countries are controversially discussed and potentially confounded by coinfection with viral hepatitis. Significant HS (more than 10% of hepatocytes) can be accurately assessed using controlled attenuation parameter (CAP) determination. Aim of this study was to assess prevalence and factors associated with significant HS in HIV monoinfected patients.A total of 364 HIV-infected patients (289 monoinfected) were included in this prospective, cross-sectional study. All patients underwent CAP determination. Steatosis was classified as S1 (significant steatosis) with CAP > 238 dB/m, S2 with CAP > 260 dB/m, and S3 with CAP > 292 dB/m. Multivariable logistic regression analyses were performed to assess the factors associated with HS in this cohort.Significant HS was detected in 118 monoinfected patients (149 in the total cohort). In the total cohort as well as in the monoinfected patients alone, HS grade distribution showed a similar pattern (S1:29%, S2:34%, and S3:37%). Interestingly, patients with HS had a longer history of HIV infection and combined antiretroviral therapy (cART). Interalia, age, gender, ethnicity, and metabolic factors were strongly associated with HS, while body mass index (BMI), triglyceride, and glycated hemoglobin (HbA1c) levels were independently associated with significant HS.HS is highly prevalent among HIV monoinfected patients. Although metabolic risk factors, such as obesity and poorly controlled diabetes, are independently associated with HS in HIV monoinfected patients, cART and control of HIV seem to play an indirect role in the development of HS, probably through the return-to-health effect.

AB - Prevalence and risk factors for hepatic steatosis (HS) in the human immunodeficiency virus (HIV)-positive population of western countries are controversially discussed and potentially confounded by coinfection with viral hepatitis. Significant HS (more than 10% of hepatocytes) can be accurately assessed using controlled attenuation parameter (CAP) determination. Aim of this study was to assess prevalence and factors associated with significant HS in HIV monoinfected patients.A total of 364 HIV-infected patients (289 monoinfected) were included in this prospective, cross-sectional study. All patients underwent CAP determination. Steatosis was classified as S1 (significant steatosis) with CAP > 238 dB/m, S2 with CAP > 260 dB/m, and S3 with CAP > 292 dB/m. Multivariable logistic regression analyses were performed to assess the factors associated with HS in this cohort.Significant HS was detected in 118 monoinfected patients (149 in the total cohort). In the total cohort as well as in the monoinfected patients alone, HS grade distribution showed a similar pattern (S1:29%, S2:34%, and S3:37%). Interestingly, patients with HS had a longer history of HIV infection and combined antiretroviral therapy (cART). Interalia, age, gender, ethnicity, and metabolic factors were strongly associated with HS, while body mass index (BMI), triglyceride, and glycated hemoglobin (HbA1c) levels were independently associated with significant HS.HS is highly prevalent among HIV monoinfected patients. Although metabolic risk factors, such as obesity and poorly controlled diabetes, are independently associated with HS in HIV monoinfected patients, cART and control of HIV seem to play an indirect role in the development of HS, probably through the return-to-health effect.

KW - Adult

KW - Age Factors

KW - Aged

KW - Anti-Retroviral Agents/therapeutic use

KW - Body Mass Index

KW - Comorbidity

KW - Cross-Sectional Studies

KW - Drug Therapy, Combination

KW - Fatty Liver/epidemiology

KW - Female

KW - HIV Infections/drug therapy

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Risk Factors

KW - Severity of Illness Index

KW - Sex Factors

KW - Young Adult

KW - liver injury

KW - NAFLD

KW - HIV monoinfection

KW - cART

KW - CAP

U2 - 10.1097/MD.0000000000010462

DO - 10.1097/MD.0000000000010462

M3 - Journal article

C2 - 29702998

VL - 97

JO - Medicine

JF - Medicine

SN - 0025-7974

IS - 17

M1 - e0462

ER -