1
|
Fourman LT, Stanley TL, Zheng I, Pan CS, Feldpausch MN, Purdy J, Aepfelbacher J, Buckless C, Tsao A, Corey KE, Chung RT, Torriani M, Kleiner DE, Hadigan CM, Grinspoon SK. Clinical Predictors of Liver Fibrosis Presence and Progression in Human Immunodeficiency Virus-Associated Nonalcoholic Fatty Liver Disease. Clin Infect Dis 2021; 72:2087-2094. [PMID: 32270862 DOI: 10.1093/cid/ciaa382] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) affects more than one-third of people living with human immunodeficiency virus (HIV). Nonetheless, its natural history is poorly understood, including which patients are most likely to have a progressive disease course. METHODS We leveraged a randomized trial of the growth hormone-releasing hormone analogue tesamorelin to treat NAFLD in HIV. Sixty-one participants with HIV-associated NAFLD were randomized to tesamorelin or placebo for 12 months with serial biopsies. RESULTS In all participants with baseline biopsies (n = 58), 43% had hepatic fibrosis. Individuals with fibrosis had higher NAFLD Activity Score (NAS) (mean ± standard deviation [SD], 3.6 ± 2.0 vs 2.0 ± 0.8; P < .0001) and visceral fat content (mean ± SD, 284 ± 91 cm2 vs 212 ± 95 cm2; P = .005), but no difference in hepatic fat or body mass index. Among placebo-treated participants with paired biopsies (n = 24), 38% had hepatic fibrosis progression over 12 months. For each 25 cm2 higher visceral fat at baseline, odds of fibrosis progression increased by 37% (odds ratio, 1.37 [95% confidence interval, 1.03-2.07]). There was no difference in baseline NAS between fibrosis progressors and nonprogressors, though NAS rose over time in the progressor group (mean ± SD, 1.1 ± 0.8 vs -0.5 ± 0.6; P < .0001). CONCLUSIONS In this longitudinal study of HIV-associated NAFLD, high rates of hepatic fibrosis and progression were observed. Visceral adiposity was identified as a novel predictor of worsening fibrosis. In contrast, baseline histologic characteristics did not relate to fibrosis progression.
Collapse
Affiliation(s)
- Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Takara L Stanley
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Isabel Zheng
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Chelsea S Pan
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan N Feldpausch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Purdy
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Julia Aepfelbacher
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Colleen Buckless
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Tsao
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen E Corey
- Liver Center, Gastroenterology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond T Chung
- Liver Center, Gastroenterology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Colleen M Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Bunn HT, Rosenthal E, Mathur P, McLaughlin M, Proschan M, Vijan A, Aepfelbacher J, Kottilil S, Masur H, Kattakuzhy S, George JM. The Effect of GS-548351 on the Pharmacokinetics of Midazolam Following Multiple Doses of ANS-6637 in Healthy Adults. J Clin Pharmacol 2020; 60:1598-1605. [PMID: 32578227 PMCID: PMC10833274 DOI: 10.1002/jcph.1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022]
Abstract
ANS-6637, a pro-drug of GS-548351, is a selective, reversible inhibitor of aldehyde dehydrogenase isoform 2 under development as an anticraving agent for the treatment of substance use disorders. In vitro testing indicates that GS-548351 is an inhibitor and inducer of cytochrome P450 family 3, subfamily A (CYP3A). In this phase 1 single-center, open-label, fixed-sequence drug-drug interaction study we assessed the impact of steady-state GS-548351 on single-dose pharmacokinetics of midazolam, an index substrate for CYP3A. Twelve healthy volunteers received 600 mg of ANS-6637 by mouth daily from study days 3 to 8 and a single 5-mg oral dose of midazolam on days 1 and 8. Pharmacokinetic samples were collected over 24 hours on days 1 and 8, then analyzed using liquid chromatography-tandem mass spectrometry. The prespecified no-effect range for the 90% confidence interval (CI) of the geometric mean ratio (GMR) of midazolam coadministered with ANS-6637 (day 8) compared with midazolam alone (day 1) was 0.7-1.43. There was an increase in midazolam AUC0-∞ (GMR [90%CI]) that was within the no-effect range (1.26 [1.12-1.425]) and an increase in midazolam Cmax that was outside the range (1.22 [1.03-1.45]). The AUC0-∞ (1.08 [0.91-1.27]) and Cmax (0.95 [0.75-1.2]) of 1-hydroxymidazolam, the primary metabolite of midazolam, were also within the no-effect range. A single grade 3 adverse event (alanine aminotransferase elevation) was identified and resolved following discontinuation of the study drug. Overall, multidose ANS-6637 was well tolerated and did not alter the PK of midazolam beyond a small increase in AUC0-∞ that is unlikely to be clinically significant.
Collapse
Affiliation(s)
- Haden T. Bunn
- Clinical Pharmacokinetics Research Laboratory, Clinical Center Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Elana Rosenthal
- Institute of Human Virology, Division of Clinical Care and Research, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
- DC PFAP Comorbidities Program, Washington, DC and Baltimore, Maryland, USA
| | - Poonam Mathur
- Institute of Human Virology, Division of Clinical Care and Research, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mary McLaughlin
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Proschan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Arjun Vijan
- Neurocrine Biosciences, San Diego, California, USA
| | - Julia Aepfelbacher
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Shyamasundaran Kottilil
- Institute of Human Virology, Division of Clinical Care and Research, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
- DC PFAP Comorbidities Program, Washington, DC and Baltimore, Maryland, USA
| | - Henry Masur
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Sarah Kattakuzhy
- Institute of Human Virology, Division of Clinical Care and Research, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
- DC PFAP Comorbidities Program, Washington, DC and Baltimore, Maryland, USA
| | - Jomy M. George
- Clinical Pharmacokinetics Research Laboratory, Clinical Center Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| |
Collapse
|
3
|
Balmaceda JB, Aepfelbacher J, Belliveau O, Chaudhury CS, Chairez C, McLaughlin M, Silk R, Gross C, Kattakuzhy S, Rosenthal E, Kottilil S, Kleiner DE, Hadigan C. Long-term changes in hepatic fibrosis following hepatitis C viral clearance in patients with and without HIV. Antivir Ther 2020; 24:451-457. [PMID: 31359874 DOI: 10.3851/imp3327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND While acute changes in hepatic fibrosis are recognized shortly after achieving sustained virological response (SVR) using direct-acting antiviral therapies, long-term outcomes for the growing population of successfully treated patients with HCV remain uncertain. The aim of this study is to characterize long-term changes in fibrosis following SVR in patients with and without HIV and to identify potential factors associated with progression or regression of fibrosis. METHODS We completed a prospective longitudinal study of 162 subjects with HCV (34% HIV-coinfected) with pre-treatment fibrosis stage determined by liver biopsy and post-SVR transient elastography. Progression of fibrosis was defined as a two-stage or greater increase in fibrosis, while regression was defined as a two-stage or greater decrease at last follow-up. The median duration of follow-up was 4.1 years. RESULTS Fibrosis progression occurred in 4% of subjects while regression occurred in 7% and 89% were stable and did not differ by HIV coinfection. Fibrosis progression was associated with increased body mass index (BMI), hepatic steatosis and smoking pack-years. In a multivariable logistic regression, HIV coinfection (P=0.009), lower steatosis score (P<0.05) and lower smoking pack-years (P=0.0007) were associated with a lower fibrosis score at last follow-up. CONCLUSIONS We identify potentially important relationships between BMI, hepatic steatosis and smoking, and changes in hepatic fibrosis post-SVR in patients with and without HIV coinfection. Attention to modifiable risk factors such as body weight and smoking may reduce the risk of liver disease progression in the growing population of successfully treated chronic HCV patients.
Collapse
Affiliation(s)
- Julia B Balmaceda
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Julia Aepfelbacher
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Olivia Belliveau
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Chloe S Chaudhury
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Cheryl Chairez
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Mary McLaughlin
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Rachel Silk
- Division of Clinical Care and Research, Institute of Human Virology, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Chloe Gross
- Division of Clinical Care and Research, Institute of Human Virology, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Sarah Kattakuzhy
- Division of Clinical Care and Research, Institute of Human Virology, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Elana Rosenthal
- Division of Clinical Care and Research, Institute of Human Virology, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| |
Collapse
|
4
|
Stanley TL, Fourman LT, Feldpausch MN, Purdy J, Zheng I, Pan CS, Aepfelbacher J, Buckless C, Tsao A, Kellogg A, Branch K, Lee H, Liu CY, Corey KE, Chung RT, Torriani M, Kleiner DE, Hadigan CM, Grinspoon SK. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV 2019; 6:e821-e830. [PMID: 31611038 DOI: 10.1016/s2352-3018(19)30338-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a substantial cause of comorbidity in people with HIV and there are no proven pharmacological treatments for the disease in this population. We assessed the effects of tesamorelin on liver fat and histology in people with HIV and NAFLD. METHODS This randomised, double-blind, multicentre study with identical placebo as a comparator was done in a hospital and a medical research centre in the USA. People with HIV infection and a hepatic fat fraction (HFF) of 5% or more by proton magnetic resonance spectroscopy were eligible. Participants were randomly assigned (1:1) to receive either tesamorelin 2 mg once daily or placebo once daily for 12 months, followed by a 6-month open-label phase during which all participants received tesamorelin 2 mg daily. The randomisation list was prepared by the study statistician using a permuted block algorithm within each stratum with randomly varying block sizes. The primary endpoint was change in HFF between baseline and 12 months. The primary safety endpoint was glucose. Analysis was by intention to treat using all available data. This trial is registered with ClinicalTrials.gov, number NCT02196831. FINDINGS 61 patients were enrolled between Aug 20, 2015, and Jan 16, 2019, of whom 30 received tesamorelin and 30 received placebo. Patients receiving tesamorelin had a greater reduction of HFF than did patients receiving placebo, with an absolute effect size of -4·1% (95% CI -7·6 to -0·7, p=0·018), corresponding to a -37% (95% CI -67 to -7, p=0·016) relative reduction from baseline. After 12 months, 35% of individuals receiving tesamorelin and 4% receiving placebo had a HFF of less than 5% (p=0·0069). Changes in fasting glucose and glycated haemoglobin were not different between groups at 12 months. Individuals in the tesamorelin group experienced more localised injection site complaints than those in the placebo group, though none were judged to be serious. INTERPRETATION Tesamorelin might be beneficial in people with HIV and NAFLD. Further studies are needed to determine the long-term effects of tesamorelin on liver histology. FUNDING National Institutes of Health and National Institute of Allergy and Infectious Diseases.
Collapse
Affiliation(s)
- Takara L Stanley
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan N Feldpausch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julia Purdy
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA
| | - Isabel Zheng
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chelsea S Pan
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julia Aepfelbacher
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA
| | - Colleen Buckless
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew Tsao
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anela Kellogg
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA; Frederick National Laboratory for Cancer Research, Frederick, MA, USA
| | - Karen Branch
- Massachusetts General Hospital Clinical Research Center, Boston, MA, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | - Chia-Ying Liu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen E Corey
- Liver Center, Gastroenterology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Liver Center, Gastroenterology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Colleen M Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health and University of Maryland, Bethesda, MD, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
5
|
Mee TC, Aepfelbacher J, Krakora R, Chairez C, Kvaratskhelia N, Smith B, Sandfort V, Hadigan C, Morse C, Hammoud DA. Carotid magnetic resonance imaging in persons living with HIV and 10-year atherosclerotic cardiovascular disease risk score. Antivir Ther 2019; 23:695-698. [PMID: 30088806 DOI: 10.3851/imp3258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Both traditional and HIV-specific risk factors contribute to greater incidence of cardiovascular disease in persons living with HIV (PLWH). Using state-of-the-art, high-resolution magnetic resonance (MR) imaging of the common carotid arteries, this study aimed to evaluate the relationship between carotid vessel wall thickness (c-VWT) and atherosclerotic cardiovascular disease (ASCVD) risk score in PLWH. METHODS Cross-sectional determinations of c-VWT using MR imaging in virally suppressed PLWH without known cardiovascular disease (n=32) and matched controls (n=13) were completed. Clinical data, including ASCVD risk and c-VWT, were compared between groups and regression analyses performed to identify predictors of c-VWT. RESULTS PLWH had significantly higher c-VWT (1.15 ±0.11 mm versus 1.08 ±0.08 mm; P=0.02) as well as higher diastolic blood pressure compared to controls, but exhibited no differences in 10-year ASCVD risk score, systolic blood pressure or smoking. Ten-year ASCVD risk score (r=0.53, P-value =0.0002), age (r=0.30, P-value <0.05), triglycerides (r=0.33, P-value =0.03) and waist circumference (r=0.36, P-value =0.02) were significantly associated with increased c-VWT. Among PLWH, c-VWT did not differ by protease inhibitor use. In a multivariate regression analysis, ASCVD risk score was the only variable significantly associated with c-VWT (P-value =0.02), whereas, HIV status was not. CONCLUSIONS In this cross-sectional study MR imaging demonstrated that c-VWT, a known marker for CVD risk, was increased in PLWH relative to controls, and that 10-year ASCVD risk was closely related to c-VWT, independent of HIV infection. Our data suggest that traditional cardiovascular disease risk factors in PLWH are adequately captured in the ASCVD risk score which was closely associated with subclinical carotid disease.
Collapse
Affiliation(s)
- Thomas C Mee
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Julia Aepfelbacher
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Rebecca Krakora
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Cheryl Chairez
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Nina Kvaratskhelia
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Bryan Smith
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Veit Sandfort
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD, USA
| | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Caryn Morse
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Dima A Hammoud
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD, USA
| |
Collapse
|