Study finds no drop in hepatic steatosis risk after HCV treatment in people with HIV/HCV coinfection

In people living with HIV and hepatitis C (HCV), hepatic steatosis incidence did not decline after successful HCV treatment, indicating the need for continued liver health monitoring, a Canadian study reports. Researchers also found that the controlled attenuation parameter was a better measure of hepatic steatosis than the Hepatic Steatosis Index in this population.

About This Study

“Changes in Hepatic Steatosis Before and After Direct-Acting Antiviral Treatment in People With HIV and Hepatitis C Coinfection” was published online on Oct. 17, 2024, in Journal of Infectious Diseases. The lead author is Esther Truscello of the Faculty of Health, Medicine, and Life Sciences at Maastricht University in Maastricht, The Netherlands.

Key Research Findings

As part of a multicenter, open prospective study, researchers investigated hepatic steatosis–which can worsen liver disease–among 431 people living with HIV in Canada whose hepatitis C was cured with direct acting antivirals. At baseline, the median age was around 51 years, about 30% of participants were women, and hepatitis C had been acquired an average of >20 years before the study. Steatosis was measured by the Hepatic Steatosis Index in 399 participants and by the controlled attenuation parameter, an ultrasound-based technique to estimate hepatic fat content, in 98 participants.

Hepatitis C treatment did not reduce hepatic steatosis incidence long-term. The adjusted slope of the controlled attenuation parameter gradually increased during treatment (from 3.3 dB/m to 3.9 dB/m). The adjusted slope of the Hepatic Steatosis Index steeply decreased during treatment (-4.5) but returned to the pre-treatment 0.2 after a sustained virologic response to hepatitis C had been achieved.

Having taken early antiretrovirals containing dideoxynucleoside was associated with a higher risk of pre-treatment steatosis, but taking integrase inhibitors showed no such association.

Discussion Highlights and Implications for Practice

Study limitations reported included the small number of participants with controlled attenuation parameter data, the choices made when modeling the data, and the fact that all participants were living with both HIV and hepatitis C.

The authors pointed out that if chronic hepatitis C was the main cause of hepatic steatosis, the expectation would be for an improvement after treatment. However, these results show that hepatic steatosis does not respond to direct-acting antivirals. The condition is currently managed by losing weight and adopting a healthier lifestyle, they said.

Continued monitoring of liver health after hepatitis C cure is warranted, the researchers remarked. Among noninvasive tools for that purpose, they reported that the controlled attenuation parameter reflects changes in hepatic steatosis better than does the Hepatic Steatosis Index.

By Barbara Jungwirth