Hepatic steatosis associated with increased central body fat by dual-energy X-ray absorptiometry and uncontrolled HIV in HIV/hepatitis C co-infected persons

BODY COMPOSITION CHANGES IN MEN WITH HIV/HCV COINFECTION, HIV MONOINFECTION, AND HCV MONOINFECTION

Context

Both human immunodeficiency virus (HIV) infection and hepatitis C virus (HCV) infection represent systemic diseases that may develop metabolic complications, thus HIV/HCV coinfection metabolic changes need to be depicted.

Objective

We aimed to evaluate the body composition changes in patients with either HIV and HCV monoinfections or HIV/HCV coinfection.

Methods

123 young men divided into three groups: 41 with HIV/HCV coinfection, 42 with HIV-monoinfection, and 40 with HCV-monoinfection were evaluated for total and regional bone and soft tissue body composition assessments using a Dual-energy X-ray absorptiometry (DXA) and were compared with 40 healthy men with age and body mass index similar to the study groups. To detect sarcopenia, we calculated the appendicular limbs' lean mass index (ALMI), for obesity, we used the percent of body fat, and for lipodystrophy, we calculated the trunk/limbs index.

Results

HIV/HCV coinfection is associated with a significant higher bone demineralization in all regions of interest compared to HCV or HIV monoinfections and to controls. The prevalence of bone demineralization in HIV/HCV patients was 31.7%, more frequently at lumbar spine. Fat mass and lean mass were significantly lower in HIV/HCV-coinfected patients than in controls. Lipodystrophy was found in similar percentages in all three evaluated groups (80.4% in HIV/HCV, 92.5% in HIV, and 95% in the HCV group). Sarcopenia was higher in HIV/HCV group (43.9%) and important in HCV-monoinfection group (30%).

Conclusions

HIV/HCV-coinfected patients had the highest prevalence of bone demineralization, fat mass, and lean mass loss, compared to controls and to HIV and HCV monoinfections.

Progressive increases in fat mass occur in adults living with HIV on antiretroviral therapy, but patterns differ by sex and anatomic depot

OBJECTIVES

Although weight gain on ART is common, the long-term trajectory of and factors affecting increases in fat mass in people living with HIV are not well described.

METHODS

Men and women living with HIV in the Modena HIV Metabolic Clinic underwent DXA scans every 6-12 months for up to 10 years (median 4.6 years). Regression modelling in both combined and sex-stratified models determined changes in and clinical factors significantly associated with trunk and leg fat mass over the study period.

RESULTS

A total of 839 women and 1759 men contributed two or more DXA scans. The baseline median age was 44 years and BMI 22.9 kg/m2; 76% were virologically suppressed on ART at baseline. For both sexes, trunk and leg fat consistently increased over the study period, with mean yearly trunk and leg fat gain of 3.6% and 7.5% in women and 6.3% and 10.8% in men, respectively. In multivariate analysis, factors associated with greater fat mass included female sex, per-year ART use (specifically tenofovir disoproxil fumarate and integrase strand transfer inhibitor therapy), per-unit BMI increase, no self-reported physical activity and CD4 nadir <200 cells/mm3.

CONCLUSIONS

Among people living with HIV on ART, trunk and leg fat mass increased steadily over a median of 4.6 years of follow up, particularly among women. After controlling for traditional risk factors, HIV- and ART-specific risk factors emerged.

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in patients with HIV

Liver disease is a leading cause of morbidity and mortality among people with HIV, and in this era of safer and more effective hepatitis C therapy, non-alcoholic fatty liver disease (NAFLD) could soon emerge as the most common liver disease in this population. NAFLD is common among patients with HIV, and might be more likely to progress to non-alcoholic steatohepatitis (NASH) and NAFLD-related fibrosis or cirrhosis in these patients than in individuals without HIV. Several mechanisms of NAFLD pathogenesis are postulated to explain the disease severity in patients with HIV; these mechanisms include the influence of the gut microbiome, and also metabolic, genetic, and immunological factors. Although treatment strategies are currently based on modification of NAFLD risk factors, many new drugs are now in clinical trials, including trials specifically in patients with HIV. Thus, the identification and risk-stratification of patients with HIV and NAFLD are becoming increasingly important for accurately counselling of these patients regarding their prognosis and for establishing the most appropriate disease-altering therapy.

Adipokines, cytokines and body fat stores in hepatitis C virus liver steatosis

AIM: To identify patients with or without liver steatosis and its severity in treatment-naïve patients affected by hepatitis C virus (HCV) infection.

METHODS: We included 56 HCV infected patients, and assessed the amount of liver fat by histomorphometry, and its relationships with fat and lean mass at different parts of the body (by densitometry), hormones [insulin, homeostatic model assessment (HOMA)], adipokines (resistin, adiponectin, leptin), and cytokines (tumor necrosis factor α, interleukin-6).

RESULTS: Although the intensity of liver steatosis is related to trunk fat mass and HOMA, 33% of patients showed no liver steatosis, and this finding was not related to body mass index or genotype. Besides trunk fat mass, no other factor was related to the presence or not of liver steatosis, or to the intensity of it, by multivariate analysis. Lean mass was not related to liver steatosis. Adiponectin levels were lower among patients. No differences were observed in leptin and resistin.

CONCLUSION: Steatosis in HCV infection is common (67.2%), and closely related to trunk fat, and insulin resistance, but not with leg fat mass or adipokines.

Serum leptin level mediates the association of body composition and serum C-reactive protein in HIV-infected persons on antiretroviral therapy

Higher body mass index (BMI) is associated with increased serum C-reactive protein (CRP) levels in HIV-infected individuals on antiretroviral therapy (ART), but the relationship of adipose tissue mass to systemic inflammation is not well described in this population. We hypothesized that serum adipokine levels (i.e., hormones produced by adipocytes) are a superior predictor of CRP compared to anthropometric or radiographic measures of body composition in patients on effective, stable ART. We evaluated the relationship of serum leptin, adiponectin, and resistin, BMI, and dual energy x-ray absorptiometry (DEXA) measurements with serum highly sensitive CRP (hsCRP) in a cross-sectional cohort of 106 predominantly virologically suppressed, HIV-infected adults on ART for ≥24 weeks using multivariable linear regression and formal criteria to assess statistical mediation. Median BMI, hsCRP, and leptin values were 25.2 kg/m(2), 3.0 mg/liter, and 3.8 ng/ml, respectively. BMI and DEXA limb fat, body fat, and trunk fat measurements were significantly associated with both serum leptin and hsCRP levels (all p≤0.02). Leptin was also associated with hsCRP (p<0.01). The regression coefficient for the effect of BMI or DEXA measurements on hsCRP was reduced, and the relationship was no longer statistically significant, after adjusting for leptin, indicating leptin functioned as a mediating variable within these relationships. Adiponectin and resistin levels did not demonstrate similar effects. Serum leptin was a superior predictor of hsCRP compared to BMI and DEXA body fat measurements, which may reflect alterations in body composition in treated HIV infection and the important contribution of adipose tissue to inflammation in this population.

HIV and hepatitis C co-infection: the role of HAART in HIV/hepatitis C virus management

PURPOSE OF REVIEW

Highly active antiretroviral therapy (HAART)-related hepatotoxicity, a relevant side effect in HIV/hepatitis C virus (HCV) co-infected patients, has evolved over time. Antiretroviral therapy might have a positive effect on the liver of HIV/HCV co-infected patients, but data are conflicting.

RECENT FINDINGS

HIV treatments have evolved and we have currently a drug armamentarium with a good liver safety profile. Most of the current first-line HAART regimens recommended by guidelines fit well to HIV/HCV co-infected patients. There are now multiple retrospective studies that suggest a possible benefit of HIV control and protection of CD4 cell counts to the liver of HIV/HCV co-infected patients. However, data are conflicting at times. This factor along with the methodological limitations of these studies prevent us from drawing definitive conclusions. Even assuming a positive effect, HAART does not appear to fully correct the adverse effect of HIV infection on HCV-related outcomes. In the era of HCV direct antiviral agents, the timing of HIV and HCV therapies has to be individualized in HIV/HCV co-infected patients given the variety of scenarios.

SUMMARY

With current HIV drug armamentarium it is possible to construct HAART regimens with optimal liver safety profile for HCV co-infected patients. The possible positive effect of HAART on the HCV-infected liver should not distract from the main intervention, which is HCV eradication with specific treatment.

Estimation of total-body and regional soft tissue composition from DXA bone densitometry of the lumbar spine and hip

The percent fat in soft tissues adjacent to the lumbar spine and proximal femur, which are required parameters in the calculation of bone mineral by conventional dual-energy X-ray absorptiometry (DXA) of the spine and hip, were analyzed for their relationship with the total-body soft tissue-scanning derivatives. The cohort (N=149), consisting of stable actively treated male human immunodeficiency virus HIV-positive patients, was split in half to obtain prediction equations with one half to be validated by the other half. Prediction equations for the dependent variables total-body fat, total-body lean mass, trunk fat, total arm + leg fat, and leg fat were derived by step-down multiple regression. A Bland-Altman comparison of the predicted and observed values showed that the limits of agreement were too large to be clinically helpful. The correlations of the ratio of adjacent spine/hip fat with ratios of trunk/arm + leg fat and trunk/leg fat, markers of peripheral lipoatrophy in HIV, were 0.725 and 0.780, respectively. The 3 ratios were compared with the clinical diagnosis of the presence or absence of peripheral lipoatrophy by receiver operating characteristic analysis. The area under the curve was 0.720 for adjacent spine/hip fat ratio and 0.655 and 0.699 for trunk/arm + leg fat and trunk/leg fat, respectively; they were not significantly different. In conclusion, for male HIV-positive patients, the difference between predicted values and actual values rendered limits of agreement that were too wide to be clinically acceptable. The ratio of percent fat in the lumbar spine region to percent fat in the proximal femur region reflected the presence of peripheral lipoatrophy as effectively as the trunk/peripheral fat ratio that was derived from the total-body scan.