Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus

Mark S. Sulkowski, Shruti H. Mehta, Michael Torbenson, Nezam H. Afdhal, Lisa Mirel, Richard D. Moore, David L. Thomas

Research output: Contribution to journalArticlepeer-review

159 Scopus citations


Objective: To ascertain the prevalence and severity of hepatic steatosis among patients coinfected with HIV and hepatitis C virus (HCV) who had been taking antiretroviral therapy (ART); to investigate if steatosis is associated with more advanced liver disease, and to identify factors that might contribute to the process. Methods: Steatosis was assessed among a randomly selected subset of HIV-HCV-coinfected patients who had received at least 2 years of ART in a cohort study at the Johns Hopkins University HIV clinic. Liver histology was evaluated by a single pathologist. The primary outcome measure was the hepatic steatosis grade, which was classified on a 5 point scale: 0, none; 1, steatosis involving < 5% of hepatocytes; 2, 5-29%; 3, 30-60%; 4 > 60%. Results: Liver histology was assessed in 112 patients, 74% of whom were taking ART at the time of biopsy. The median cumulative exposure to nucleoside reverse transcriptase inhibitors and protease inhibitors was 5.8 and 3.7 years, respectively. No steatosis was detected in 60%; grades 2-4 steatosis was recognized in 18%. In multivariate analysis, steatosis was independently associated with Caucasian race, weight > 86 kg, hyperglycemia, and stavudine use. Patients with steatosis also were more likely to have greater hepatic fibrosis (P = 0.02) and necroinflammatory activity (P = 0.005). Conclusions: Steatosis was observed in 40% of HIV-HCV-coinfected patients with extensive ART exposure and was associated with more severe HCV-related liver disease. Metabolic abnormalities (excess weight and hyperglycemia) and stavudine use were modifiable risk factors for steatosis in this population.

Original languageEnglish (US)
Pages (from-to)585-592
Number of pages8
Issue number6
StatePublished - Mar 24 2005


  • Antiretroviral drugs
  • HIV
  • HIV-HCV coinfected
  • Hepatitis C
  • Lipodystrophy
  • Liver disease
  • Liver steatosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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