BACKGROUND Both HIV and hepatitis C virus (HCV) infection increase the risk of hepatic steatosis (HS), which in turn contributes to the severity and progression of liver disease. Direct acting antivirals (DAAs) can cure HCV but whether they reduce HS is unclear. METHODS HS was assessed using the controlled attenuation parameter (CAP) and the hepatic steatosis index (HSI) in participants coinfected with HIV-HCV from the Canadian Coinfection Cohort. Changes in HS, before, during and after successful DAA treatment, were estimated using generalized additive mixed models, adjusted for covariates measured prior to treatment (age, sex, duration of HCV infection, body mass index, diabetes, prior exposure to dideoxynucleosides and hazardous drinking). RESULTS 431 participants with at least one measure of CAP or HSI before treatment were included. CAP steadily increased over time: adjusted annual slope 3.3 dB/m (95% credible interval (CrI) 1.6, 4.9) before, and 3.9 dB/m (95% CrI: 1.9, 5.9) after DAA treatment, irrespective of pre-treatment CAP. In contrast, HSI changed little over time: annual slope 0.2 (95% CrI: -0.1, 0.5) before and 0.2 (95% CrI -0.1, 0.5) after, but demonstrated a marked reduction during treatment -4.5 (95% CrI -5.9, -3.1). CONCLUSIONS When assessed by CAP, HS was unaffected by DAA treatment and steadily increased over time. In contrast, HSI did not appear to reflect changes in HS, with the decrease during treatment likely related to resolution of hepatic inflammation. Ongoing HS may pose a risk for liver disease in coinfected people cured of HCV.

中文翻译：

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HIV 感染者和丙型肝炎合并感染者直接作用抗病毒治疗前后肝脂肪变性的变化。


背景 HIV 和丙型肝炎病毒 （HCV） 感染都会增加肝脂肪变性 （HS） 的风险，这反过来又会导致肝病的严重程度和进展。直接作用抗病毒药物 （DAAs） 可以治愈 HCV，但它们是否能降低 HS 尚不清楚。方法 使用受控衰减参数 （CAP） 和肝脂肪变性指数 （HSI） 评估来自加拿大合并感染队列的 HIV-HCV 参与者的 HS。使用广义加性混合模型估计 DAA 治疗成功之前、期间和之后 HS 的变化，并根据治疗前测量的协变量（年龄、性别、HCV 感染持续时间、体重指数、糖尿病、既往暴露于二脱氧核苷和危险饮酒）进行调整。结果 纳入 431 例治疗前至少进行一项 CAP 或 HSI 测量的参与者。CAP 随着时间的推移稳步增加：调整后的年斜率为 3.3 dB/m（95% 可信区间 （CrI） 1.6、4.9），DAA 处理后为 3.9 dB/m（95% CrI：1.9、5.9），与处理前 CAP 无关。相比之下，HSI 随时间变化不大：年斜率 0.2 （95% CrI： -0.1， 0.5） 之前和 0.2 （95% CrI -0.1， 0.5），但在处理期间表现出显着降低 -4.5 （95% CrI -5.9， -3.1）。结论 当通过 CAP 评估时，HS 不受 DAA 治疗的影响，并且随着时间的推移稳步增加。相比之下，HSI 似乎没有反映 HS 的变化，治疗期间的减少可能与肝脏炎症的消退有关。持续的 HS 可能会对 HCV 治愈的合并感染者构成肝病风险。