Hepatic Steatosis and Metabolic Syndrome Variables: Overplay on the Progression of Fibrosis among Hepatitis C Mono-Infected Patients and Human Immunodeficiency Virus Co-Infected Patients

Background & Aims: Hepatic steatosis has been reported to be associated to increased fibrosis progression, reduced response rates to anti-HCV therapy and antiretroviral therapy for which it has clinical importance. This study was conducted to determine the impact of hepatic steatosis on the severity of liver disease progression in chronic HCV mono-infected and HIV/HCV co-infected patients. Methods: Retrospective study of patients with chronic HCV or HIV/HCV coinfection, with liver biopsies, at the Fundación de Investigación in Puerto Rico and the Bronx Veterans Affairs Medical Center in New York from 1998 to 2005. Results: Of the 1212 subjects, 834 (69%) were HCV mono-infected and 378 (31%) were HIV/HCV co-infected. Steatosis was more prevalent in HCV patients than HIV/HCV patients (51.2% vs. 39.7%, p=0.003). Severity of necroinflammatory grade was statistically associated to steatosis in HCV patients (p < 0.001), but not HIV/HCV patients (p=0.620). Severity of fibrosis progression rate was associated to steatosis in HCV patients (p=0.088), but not HIV/HCV patients (p=0.493). Hepatic steatosis increased the chances of fibrosis across all levels in the multivariate analysis (using a partial proportional odds model) in HCV patients, but not HIV/HCV patients. Conclusion: Hepatic steatosis is more prevalent in HCV mono-infected patients, than in HIV/HCV co-infected patients. Presence of steatosis impacted the progression of liver disease differently; it increased the severity of necroinflammatory grade, the fibrosis progression rate and the chances of fibrosis in HCV mono-infected patients, but not in HIV/HCV co-infected patients.