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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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29702998
OWN - NLM
STAT- MEDLINE
DCOM- 20180514
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Return-to-health effect of modern combined antiretroviral therapy potentially
      predisposes HIV patients to hepatic steatosis.
PG  - e0462
LID - 10.1097/MD.0000000000010462 [doi]
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.
FAU - Mohr, Raphael
AU  - Mohr R
AD  - Department of Medicine I, University Hospital Bonn.
AD  - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn,
      Germany.
FAU - Boesecke, Christoph
AU  - Boesecke C
AD  - Department of Medicine I, University Hospital Bonn.
AD  - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn,
      Germany.
FAU - Dold, Leona
AU  - Dold L
AD  - Department of Medicine I, University Hospital Bonn.
AD  - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn,
      Germany.
FAU - Schierwagen, Robert
AU  - Schierwagen R
AD  - Department of Medicine I, University Hospital Bonn.
FAU - Schwarze-Zander, Carolynne
AU  - Schwarze-Zander C
AD  - Department of Medicine I, University Hospital Bonn.
AD  - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn,
      Germany.
FAU - Wasmuth, Jan-Christian
AU  - Wasmuth JC
AD  - Department of Medicine I, University Hospital Bonn.
AD  - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn,
      Germany.
FAU - Weisensee, Insa
AU  - Weisensee I
AD  - Department of Medicine I, University Hospital Bonn.
FAU - Rockstroh, Jurgen Kurt
AU  - Rockstroh JK
AD  - Department of Medicine I, University Hospital Bonn.
AD  - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn,
      Germany.
FAU - Trebicka, Jonel
AU  - Trebicka J
AD  - Department of Medicine I, University Hospital Bonn.
AD  - Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
AD  - European Foundation for the Study of Chronic Liver Failure, EF Clif.
AD  - Institute for Bioengineering of Catalonia, Barcelona, Spain.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Retroviral Agents)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - Body Mass Index
MH  - Comorbidity
MH  - Cross-Sectional Studies
MH  - Drug Therapy, Combination
MH  - Fatty Liver/*epidemiology/ethnology
MH  - Female
MH  - HIV Infections/*drug therapy/*epidemiology/ethnology
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Young Adult
PMC - PMC5944472
EDAT- 2018/04/29 06:00
MHDA- 2018/05/15 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
AID - 10.1097/MD.0000000000010462 [doi]
AID - 00005792-201804270-00030 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0462. doi: 10.1097/MD.0000000000010462.