Fatty Liver Found More Often with HCV Than HCV/HIV

Sarah Sansom, DO

Rates of detecting steatosis were lower with liver biopsy than with a recently developed imaging technique in a recent study. Additionally, non-alcoholic fatty liver disease (NAFLD) was diagnosed, in divergence from some earlier studies, more often in patients with hepatitis C virus (HCV) monoinfection than with HCV and HIV coinfection.

Sarah Sansom, DO, Ruth M. Rothstein CORE Center and Rush University Medical Center, Chicago, IL, and colleagues compared steatosis detection rates with liver biopsy to detection with an imaging technique that is now more widely used in the US as a non-invasive and safer option: transient elastography (TE) with controlled attenuation parameter (CAP).

They characterized liver biopsy as the previous gold standard in diagnosing NAFLD, enabling concomitant evaluation of fibrosis, steatosis, and inflammation. TE-CAP measures the degree of ultrasound attenuation of hepatic fat simultaneously with liver stiffness measurements as an assessment of fibrosis, according to the investigators.

"CAP has also been validated by cross-sectional studies in HIV, HCV, and coinfected patients," they noted, "though cross-sectional trends in steatosis over time remain poorly studied in patients with chronic HCV and HIV."

The investigators identified a total of 1578 patients for inclusion in the retrospective study, including 421 who had engaged in care at the hepatitis center and received a liver biopsy between December 2001 and May 2014; and 1157 who engaged in care and had documented TE-CAP in the period from May 2016 to May 2017. Patients were excluded from the study if they had history of autoimmune hepatitis or hepatitis B coinfection.

The comparison of detection rates between the 2 methods was hindered, however, by the omission of any reporting of steatosis histopathology in over a quarter (26.4%) of the liver biopsy reports. Sansom attributed this to the procedure having initially been intended for fibrosis staging for HCV infection.

"We suspect that the burden of steatosis in the biopsy group may be underestimated," Sansom told MD Magazine®. "Additionally, the measurement of steatosis by CAP likely allowed for a more comprehensive representation of our population because it is a quick and non-invasive test modality that was performed during the office visit."

The investigators reported higher steatosis rates detected by CAP (24%) than with liver biopsy (11.4%). The rates of steatosis rates were higher in HCV moninfected individuals (15.7%) than in those with HCV/HIV coinfection (8.6%). The detection rates by CAP were similar for monoinfected and coinfected populations.

"Several previous studies have shown increased steatosis and fibrosis prevalence and severity in coinfected patients compared to HIV or HCV monoinfection, thought to be mediated by possible synergy between HIV and HCV in disrupting lipid metabolism," Sansom observed.

"We suspect that the lower rates of steatosis severity in our coinfected patients reflects increased long-term engagement in healthcare that may mitigate contributory metabolic factors for steatosis, together with higher rates of obesity in the HCV monoinfected patients," she commented.

The study, “Steatosis Rates by Liver Biopsy and Transient Elastography Controlled Attenuated Parameter (CAP) in Clinical Experience of Hepatitis C (HCV) and HIV/HCV Coinfection in a Large US Hepatitis Clinic,” was published in Open Forum Infectious Diseases.