Title | Screening for nonalcoholic steatohepatitis by using cytokeratin 18 and transient elastography in HIV mono-infection. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Benmassaoud, Amine, Peter Ghali, Joseph Cox, Philip Wong, Jason Szabo, Marc Deschênes, Maria Osikowicz, Bertrand Lebouche, Marina B. Klein, and Giada Sebastiani |
Journal | PLoS One |
Volume | 13 |
Issue | 1 |
Pagination | e0191985 |
Date Published | 2018 |
ISSN | 1932-6203 |
Keywords | Adult, Cross-Sectional Studies, Elasticity Imaging Techniques, Female, HIV Infections, Humans, Keratin-18, Male, Middle Aged, Non-alcoholic Fatty Liver Disease |
Abstract | BACKGROUND AND AIM: HIV-infected individuals are at high risk of developing nonalcoholic steatohepatitis (NASH), a leading cause of end-stage liver disease in Western countries. Nonetheless, due to the invasiveness of liver biopsy, NASH remains poorly understood in HIV mono-infection. We aimed to characterize the prevalence and predictors of NASH in unselected HIV mono-infected patients by means of non-invasive diagnostic tools. METHODS: HIV-infected adults without significant alcohol intake or co-infection with hepatitis B or C underwent a routine screening program employing transient elastography (TE) with controlled attenuation parameter (CAP) and the serum biomarker cytokeratin-18 (CK-18). NASH was diagnosed non-invasively as the coexistence of fatty liver (CAP ≥248 dB/m) and CK-18 >246 U/L. Identified cases of NASH were offered a diagnostic liver biopsy. Predictors of NASH were determined by multivariate logistic regression analysis. RESULTS: 202 consecutive HIV mono-infected patients were included. NASH was non-invasively diagnosed in 23 cases (11.4%). Among them, 17 underwent a liver biopsy, and histology confirmed NASH in all cases. The prevalence of NASH was higher in patients with hypertriglyceridemia (17.1%), insulin resistance defined by homeostasis model for assessment of insulin resistance (HOMA-IR) (25%), those with detectable HIV viral load (42.9%) and those with elevated ALT (53.6%). After adjustment, higher HOMA-IR (adjusted odds ratio [aOR] = 1.20, 95% CI 1.01-1.43; p = 0.03) and ALT (aOR = 2.39, 95% CI 1.50-3.79; p<0.001) were independent predictors of NASH. CONCLUSIONS: NASH, diagnosed by a non-invasive diagnostic approach employing CK-18 and TE with CAP, is common in unselected HIV mono-infected individuals, particularly in the presence of insulin resistance and elevated ALT. |
DOI | 10.1371/journal.pone.0191985 |
Alternate Journal | PLoS ONE |
PubMed ID | 29381754 |
PubMed Central ID | PMC5790260 |