Hepatic Steatosis Is Not, He Taught Me An Infection, Thing That Apacerates On An Ultrasound
Hepatic steatosis, a fatty liver disease is a growing cause of serious liver problems followed by liver-related death among people living with HIV.
Especially now that hepatitis C can be cured, according to research presented at the 2019 International Liver Congress last week in Vienna.
With highly effective treatments for hepatitis B and C leading to reduced mortality among people with HIV, "NAFLD is becoming an increasingly important cause of liver disease."
So says Zobair Younossi of the Inova Fairfax Medical Campus in Falls Church, Virginia. And he also suggests that in the future, NAFLD can become the leading cause of liver disease in this population.
As the People living with HIV are living longer thanks to effective antiretroviral treatment -nearly half of HIV-positive people now have more than 50 years- Non-HIV-related conditions such as cardiovascular diseases, non-AIDS cancers and liver diseases are a cause of increasing proportion of illness and premature loss of life in these populations.
For, to the extent that living with HIV become healthier, they are also more likely to be overweight, also noted Younossi.
Overweight? Gastrolasia and Second Pulmonary Embolism. He also had Hepatic Steatosis
Many people living with HIV also have the hepatitis B virus (HBV) or the hepatitis C virus (HCV), which are transmitted in some ways.
HIV, almost Domesticated
But an effective HBV vaccine has been available since the late 80 years, and antiviral drugs such as Viread (tenofovir disoproxil fumarate) which caused me osteoporosis and Baraclude (entecavir) can keep hepatitis B under control.
And in addition, pathologies such as hepatitis C can be cured with direct-acting antivirals.
Between the HIV-positive people - as the US population as a whole - viral hepatitis is falling as a cause of severe liver disease while NAFLD is increasing.
Non-alcoholic fatty liver disease and its most severe form, non-alcoholic hepatic steatosis (NASH), are caused by the accumulation of fat in the liver.
And this, unfortunately, triggers inflammation, which over time can lead to the development of fibrosis (scarring), cirrhosis (severe scarring and loss of liver function) as well as liver cancer.
Today, April 2019, there are no effective treatments for DHGNA and NASH, and disease management depends on lifestyle changes such as weight loss and exercise.
I myself, Cláudio Souza, had to undergo a surgical procedure that, in my case, was a matter of whether or not to survive, of gastroplasty, popularly known as stomach reduction and, you see, I evolved (...) for a second pulmonary embolism , because the first one had been on 2005 and almost sent me to the ditch, or to the sack, this second time, they disabused me, saying that I would not resist.
Hard to gnaw like a bell, my biggest threat is to me, always myself and not my pathologies! Or Hepatic Steatosis
Returning to the topic, Younossi's team analyzed trends in the prevalence and mortality of NAFLD, viral hepatitis and other liver diseases among people with HIV.
People who receive Medicare, which is generally available to people with 65 years or more and, insane culture, also some people even younger, with disabilities.
Researching the medical records of more than 47.000 HIV-positive people, they identified 10.474, or 22,3%, with some liver disease. Hepatitis C was the most common occurrence, with 5.628 cases (53,7 percent). This was followed by DHGNA (non-alcoholic fatty liver disease) in 2.629 cases (25,1 percent).
And so the other causes were less common, including 1.374 with hepatitis B (13,1 percent), 645 with coinfection with HBV and HCV (6,2 percent).
As well as 198 people, with other diseases of the liver (1,9 percent).
Thus, between 2006 and 2016, the prevalence of viral hepatitis among people with HIV decreased from 27,8 to 24,1 per 100.000 in the population (an annual percentage change of -0,9 percent).
And, meanwhile, the rate of DHGNA, hepatic steatosis, more than doubled from 5,3 to 11,6 by 100.000 (an annual variation of + 7,2%), reported once again Zobair Younossi.
A similar pattern was observed for mortality, although fatty liver disease was still responsible for fewer deaths than hepatitis C. Of the 2.882 total deaths during the study period, slightly more than one-third (36,2%) were related to liver disease . Of these, half were attributed to HCV, 20,3% to DHGNA, 14,4% to HBV, 11,9% to HBV / HCV coinfection and 3,9% to other liver diseases.
Thus, during the same decade, viral hepatitis-related death rates fell from 3,8 to 2,6 by 100.000 (annual variation of -5,2 per cent), while mortality by DHGNA increased from 0,2 to 0,8 by 100.000 (annual variation of 8,9 Percent).
All this way, analyzing in a multivariate analysis that took into account multiple risk factors, HIV-positive people with liver disease presented longer hospital stay.
As well as longer hospitalization and higher outpatient costs with higher risks of death at one year when compared to those without liver disease.
And therefore, with the growing impact of fatty liver disease among people with HIV, "doctors should be much, much more attentive to identifying and controlling NAFLD among these individuals," insisted Younossi and Zobair. And so, with the eyes set on this, a related study examined NAFLD in two cohorts of people living with HIV in Canada and Italy, among people who did not ingest too much alcohol and did not have hepatitis B or C.
Among these 1.228 people whose records were reviewed, 31,8% had NAFLD.
Of these, 25,2 percent were considered to be at risk for progression of liver disease, based on elevated levels of liver enzymes, as well as the presence of significant fibrosis. "And this is how such studies indicate the change profile of liver disease in HIV patients." Although viral hepatitis is still the leading cause of liver disease in these groups, NAFLD is becoming a much more common problem, "said Philip Newsome, PhD, deputy secretary of the European Association for the Study of Liver .
That statement was published in a press release during the conference.
"And these facts reinforce the need to study therapeutic agents in patients with NAFLD and HIV, an area that is rarely examined."
Translated by Cláudio Souza in published 05 of May of 2019, of the original in NAFLD a rising cause of liver disease in people with HIV • Per Liz Highleyman
About the author of the study
Zobair M. Younossi, MD, MPH, FACP, FACG, AGAF, is the chairman of the Medical Department of the Inova Fairfax Medical Campus. He is also a professor of medicine, Virginia Commonwealth University, Inova Campus and affiliate professor of Biomedical Sciences at George Mason University.
Dr. Younossi received his medical degree from the School of Medicine and Dentistry of the University of Rochester in Rochester, New York (Alpha Omega Alpha, 1989), and completed his residency in internal medicine, as well as a fellowship in gastroenterology and hepatology at Scripps Clinic and Research Foundation in La Jolla, California. During his residency and fellowship, he earned his MA in public health from the San Diego State University School of Public Health (SDSU) in San Diego, California, receiving the Hanlon Award and the Outstanding Student Award from SDSU. He then served as a Hepatologist and Senior Researcher at the Cleveland Clinic Foundation, Cleveland, Ohio (1995-2000).
Click here to see the summaries of the International Liver Congress.
Click here to learn more about NAFLD and NASH.