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Abnormal lipids & GGT May Predict Poor Outcome in HCV/HIV Coinfection
  Abnormal Lipids (low cholesterol & triglycerides, high glucose) May Predict Poor Outcome in HCV/HIV Coinfected
ICAAC Abstract title: "Hypolipidemia Impacts Mortality in Patients with HIV and Hepatitis C (HCV) Co-infection". Abstract H-1723; C. HSIAO, J. MIQDADI; University at Buffalo, SUNY, Buffalo, NY
Hypolipidemia (low levels of cholesterol & triglycerides) is frequently found in severe chronic hepatic insufficiency because the liver is the most active site of lipid metabolism. As well, diabetes is more prevalent in persons with hepatitis C. The study authors say that a low baseline serum cholesterol level may be associated with liver impairment and may be a sign of higher mortality risk in patients with liver cirrhosis. One of the major causes of mortality in HIV infected patients is liver related, especially, for those who had HIV HCV co-infection. The cohort study is to see if hypolipidemia impacts mortality in patients with HIV HCV co-infection. A retrospective review was conducted of records of HIV infected patients during 12/98 until 9/01 in an urban HIV Clinic at Buffalo, New York. Statistical analyses were performed using EpiInfo2000 and Prism 3.0 software to see if patient lipid abnormalities impact risk of mortality. The entire study population is 640 patients. Of which 253 patients had HCV (median age: 43; 80 Females, 173 Men; 122 Black, 75 Hispanic, 52 white and 4 others). 41 deaths had occurred during this study period with median time of 385 days (12-833 days) from the date of data collection. Analyses of lipid pr files indicated that serum cholesterol < 150 mg/dl, decreased VLDL, HDL level < 35 mg/dl or triglyceride level < 120 mg/dl were significantly associated with an increased risk of mortality with Odd Ratios (ORs) of 2.79, 1.83 and 3.80 respectively. A higher total cholesterol level (> 200 mg/dl) did not impact mortality; however, a higher triglyceride level (> 320 mg/dl) reduced mortality (P = 0.047, OR: 0.31). Hypotriglyceridemia is found to be the most weighted factor that correlates mortality in HIV HCV co-infected patients; however, it does not impact mortality in HIV-infected patients without HCV infection.
The authors concluded that hypolipidemia is a poor prognostic indicator for patients with HIV HCV co-infection. According to previous literature, hypolipidemia may be associated with patients poor nutritional status or advanced stage of liver cirrhosis. In talking with the study authors he feels that elevated glucose and low cholesterol and triglycerides may be a sign that the liver is impaired and may be a sign of more advanced liver disease. On the other hand, patients who undergo HCV therapy successfully be eliminating HCV viral burden may see an increase in cholesterol & triglycerides because the liver is functioned better. The authors suggest that hypobetalipoproteinemia in patients with HCV suggests hepatic steatosis and this can be a sign of advanced liver cirrhosis.
In a second study presented here by the same authors, they suggest that in HCV/HIV coinfected patients with either serum glucose <120 mg/dL or triglycerides <120 mg/dL with the combination of any other 2 factors or the combination of any 4 factors can predict more than 50% risk for mortality within 3 years (anemia <12 g/mL, HIV viral load >50,000 copies/ml, age >49, platelets <130,000, LDH >700 U/L (1.25 times upper limit of normal).Also, patients with hypolipidemia may be more susceptible to drug toxicity. Further studies to explore the pathogenesis of hypolipidemia in patients with HIV HCV co-infected patients are warranted.
GGT >100 Ul/ml Predicts More Advanced HCV
ICAAC Abstract title (H-1733): Features and Biochemical Markers of Histological Severity in HIV-HCV Coinfected Patients
The purpose of this study was to assess potential biochemical markers of histological severity (fibrosis and necroinflamatory activity) in HCV/HIV coinfected patients. They did a prospective analysis of the histological activity index (HAI) and fibrosis (F) in 99 liver biopsies (LB) from HCV/HIV-coinfected, excluding chronic carriers of HBsAg. We evaluated factors associated with HCV (genotype, VL, time of HCV, age at acquisition, sex), HIV (CDC stage, CD4 and VL) and alcohol abuse. Mild-moderate hepatitis was defined for HAI between 1-9, severe for HAI >10. Fibrosis > 10 was considered severe. Most patients were male (77%), mean age 38 years (range 29-51). Prior IVDU reported in 88%, and alcohol abuse in 30 (32%). Mean time of HCV infection, 17 years (range, 3-34). Median CD4 and HIV-RNA at the time of LB were 494 cells/Ál (range, 36-1260) and 2.1 log10 (range, 1,7-5,4). HCV genotype 1 was the most frequently observed (55%), and mean HCV-VL 2x106 UI/ml (range, 3x103-15x106). Hepatitis activity was mild in 29%, moderate in 58% and severe in 12% cases. LB showed a lack of fibrosis in 6%, F I in 38%, F II in 18%, F III in 26%, and cirrhosis in 12%. By univariate analysis, a GGT plasmatic level >100 UI/ml predicted a severe HAI (OR 6,9; 95% CI [1,6-29,6], p=0,007). This was also confirmed by multivariate analysis performed including potential confounding factors.
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