Regional adipose tissue and elevations in serum aminotransferases in HIV-infected individuals.
ABSTRACT The association of fat distribution with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevations is not well-defined in HIV-infected individuals. Obesity is associated with hepatic steatosis, and ALT is a marker of steatosis in the general population.
Cross-sectional analysis of 1119 HIV-infected and 284 control subjects. Hepatitis C virus (HCV) RNA testing determined HCV infection. Magnetic resonance imaging measured regional adipose tissue volume.
After adjustment for demographic and lifestyle factors, visceral adipose tissue (VAT) was positively associated with ALT in HIV/HCV-coinfected subjects (+9.8%, 95% confidence interval [CI]: 2.8 to 17.6), HIV-monoinfected subjects (+8.0%, 95% CI: 4.2 to 12.1), and controls (+5.9%, 95% CI: 2.0 to 10.1). In contrast, lower trunk subcutaneous adipose tissue (SAT) was negatively associated with ALT in HIV/HCV-coinfected subjects (-14.3%, 95% CI: -24.7 to -4.2) and HIV-monoinfected subjects (-11.9%, 95% CI: -18.4 to -5.3); there was a trend toward an association in controls (-7.1%, 95% CI: -22.7 to 5.9). Estimated associations between regional adipose tissue and AST were small and did not reach statistical significance.
More VAT and less lower trunk SAT are associated with elevated ALT, which likely reflects the presence of steatosis. There was little association with AST. HCV infection and having more VAT or less lower trunk SAT are independently associated with elevated ALT in HIV infection. Study regarding the association between VAT, trunk SAT, HCV, and progression of steatosis and fibrosis is needed in HIV-infected individuals.
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ABSTRACT: To evaluate the relationship between regional body composition and liver disease (fibrosis or steatosis) in HIV/HCV co-infected individuals. Whole body dual-energy X-ray absorptiometry (DXA) was performed in 173 HIV/HCV co-infected persons within 12 months of a liver biopsy. Significant fibrosis was defined as a METAVIR stage greater than 1. Steatosis was graded as: 0, none; 1, steatosis involving less than 5% of hepatocytes; 2, 5-29%; 3, 30-60%; 4 greater than 60%, and was defined as more than 0. Poisson regression with robust variance was used to estimate prevalence ratios of the outcome measures. The population was 62% male and 84% black with a median body mass index of 25.2 kg/m (interquartile range 22.5, 29.3 kg/m). No differences in regional body fat or fat distribution were observed in 42 patients with significant fibrosis compared to others with less fibrosis. However, the 77 individuals (45%) with steatosis had greater central fat than those without steatosis [prevalence ratio 1.04 per kg trunk fat; 95% confidence interval (CI) 1.04, 1.11], after adjusting for hepatic fibrosis (prevalence ratio 1.77; 95% CI 1.29, 2.42), uncontrolled HIV replication (viral load >400 copies/ml) (prevalence ratio 1.57; 95% CI 1.12, 2.22), age, sex, race and diabetes mellitus. In HIV/HCV co-infected individuals, measures of regional body fat or fat distribution were not associated with hepatic fibrosis. In contrast, increased central adiposity by DXA, as well as concomitant fibrosis and uncontrolled HIV, were associated with hepatic steatosis. The extent to which weight loss and effective antiretroviral therapy can reduce the risk of steatosis deserves further investigation.AIDS (London, England) 02/2010; 24(6):811-7. DOI:10.1097/QAD.0b013e3283333651 · 6.56 Impact Factor
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ABSTRACT: Background. Few studies have examined the relationship of HIV monoinfection and its associated perturbations with liver fibrosis.Methods. Using multivariable linear regression, we examined the demographic, behavioral, metabolic and viral factors associated with transient elastography-measured liver stiffness (LS) in 314 participants (165 HIV+/HCV-,78 HIV+/HCV+,14 HIV-/HCV+,57 HIV-/HCV-) of the Women's Interagency HIV Study.Results. Compared to HIV-/HCV- women, HIV+/HCV+ women had greater median LS values (7.1 vs. 4.4 kPa;p<0.0001); HIV+/HCV- and HIV-/HCV- women had similar LS (both 4.4 kPa;p=0.94). HIV/HCV coinfection remained associated with greater LS (74%, 95% confidence interval [CI]:49,104) even after multivariable adjustment. Among HCV+ women, waist circumference (WC) (per 10 cm increase) was associated with an 18% (95%CI:7.5,30) greater LS after multivariable adjustment; WC showed little association among HIV+/HCV- or HIV-/HCV- women. Among HIV+/HCV- women, history of AIDS (13%;95%CI:0.4,27) and HIV RNA (7.3%;95%CI:1.59,13.3, per 10-fold increase) were associated with greater LS.Conclusions. HCV infection but not HIV infection is associated with greater LS when compared to women with neither infection. Our finding that WC, a marker of central obesity, is associated with greater LS in HIV/HCV-coinfected but not HIV-monoinfected or women with neither infection suggests that in the absence of HCV-associated liver injury the adverse effects of obesity are lessened.The Journal of Infectious Diseases 07/2013; DOI:10.1093/infdis/jit357 · 5.78 Impact Factor
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ABSTRACT: Morphologic and metabolic abnormalities, including subcutaneous adipose tissue wasting, central adipose tissue accumulation, dyslipidemia and disorders of glucose metabolism are common among HIV-infected patients receiving highly active antiretroviral therapy (HAART) and contribute to the risk of cardiovascular disease in this population. The pathogenesis of these disorders is due to complicated interactions between effects of chronic HIV infection, HAART medications and patient factors, including genetic susceptibility. HAART has transformed HIV into a chronic condition for many patients and as a result the majority of HIV-infected patients in many areas of the developed world will soon be aged ≥50 years. Given that metabolic and cardiovascular diseases increase with aging, knowledge of the optimal management of these conditions is essential for practitioners caring for HIV-infected patients, including endocrine subspecialists. This Review highlights the clinical management of these disorders, focusing on the latest evidence regarding the efficacy of treatment strategies, newly available medications and potential interactions between HAART medications and medications used to treat metabolic disorders.Nature Reviews Endocrinology 09/2011; 8(1):11-21. DOI:10.1038/nrendo.2011.151 · 12.96 Impact Factor