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Elevated fatty liver index in HCV/HIV coinfection predicts mortality risk

Researchers discovered that an elevated fatty liver index was an independent risk factor for all-cause mortality in patients coinfected with hepatitis C and HIV, regardless of liver fibrosis or sustained virologic response to hepatitis therapy.

“Both HCV and HIV infections lead to systemic inflammation, and higher mortality from both extrahepatic and liver-related causes can be expected in coinfected patients who also have hepatic steatosis,” Tangui Barré, PhD, from the Aix-Marseille University in France, and colleagues wrote. “HIV/HCV coinfected patients are therefore prone to develop hepatic steatosis, which in turn is strongly related to the very metabolic and hepatic complications associated with higher mortality risk in this same population.”

During follow-up, 63 of 983 enrolled patients died for a mortality rate of 1.38 per 100 person-years (95% CI, 1.08-1.77). The main causes of death were HCV-related (39.7%), cancers unrelated to AIDS or hepatitis (12.7%), AIDS-related (11.1%), cardiovascular diseases (4.8%), overdoses (4.8%) and suicides (4.8%).

The researchers observed elevated fatty liver index values (60 or higher) in 118 patients at all follow-up visits and in 306 patients during at least one follow-up visit.

Multivariate analysis adjusted for HCV cure and fibrosis status revealed that elevated fatty liver index correlated with a nearly twofold increased risk for mortality (adjusted HR = 1.91; 95% CI, 1.17-3.12) compared with those without elevated values.

Additional factors associated with mortality risk included a history of hepatocellular carcinoma or liver transplantation (aHR = 7.74; 95% CI, 3.82-15.7), the presence of advanced fibrosis (aHR = 1.77; 95% CI, 1-3.14), indirect clinical signs of cirrhosis at baseline (aHR = 2.8; 95% CI, 1.22-6.41), HIV CDC clinical stage C (aHR = 2.88; 95% CI, 1.74-4.79).

However, SVR from HCV treatment (aHR = 0.21; 95% CI, 0.07-0.61) did correlate with a lower risk for mortality compared with those without SVR.

“As recommended by recent guidelines from the European Associations for the Study of the Liver, Diabetes and Obesity (EASL-EASD-EASO), serum biomarkers are suitable tools for large screening studies of steatosis, with the fatty liver index (FLI) being one of the best validated,” the researchers wrote. “In the present era of nearly 100% HCV cure rates thanks to direct-acting antivirals, these findings encourage the more systematic use of non-invasive steatosis biomarkers to help identify co-infected patients with higher mortality risk.” – by Talitha Bennett

Disclosures: Barré reports that the study was supported by the French National Agency for Research on AIDs and Viral Hepatitis with the participation of Abbott France, Bristol-Myers Squibb, GlaxoSmithKline, Merck Serono, Roche and Schering-Plough.