Since the emergence of highly active antiretroviral therapy (HAART) against HIV, there has been a substantial decline in mortality related to complications of HIV infection and acquired immunodeficiency syndrome (AIDS), however, little impact on reducing deaths related to liver disease._x000D_ Currently, liver disease in HIV patients is due to a combination of causes such as coinfection with hepatitis C virus, HAART-related hepatotoxicity, microbial translocation and metabolic disorders, such as insulin resistance (IR) and metabolic syndrome (MS)._x000D_ In HIV/HCV co-infected patients, the association of IR with liver fibrosis is especially relevant, since both HCV and HIV infection per se, as well as antiretroviral therapy and persistent chronic inflammation, cause dyslipidemia and IR, as well as intra-abdominal fat accumulation (IFA) and in the hepatocytes, that will evolve to hepatic steatosis and fibrosis and subsequent progression to cirrhosis and hepatocellular carcinoma._x000D_ The hypothesis of this thesis is that quantification of IFA by abdominal CT is a radiological marker of the severity of hepatic fibrosis in patients with HIV/HCV coinfection. The following objectives are proposed:_x000D_ a) Primary objective: To demonstrate an independent association between CT-measured IFA and the severity of hepatic fibrosis in patients with HIV/HCV coinfection._x000D_ b) Secondary objectives:_x000D_ 1. To determine the diagnostic accuracy of the radiological variables studied: IFA and quantification of hepatic steatosis in segments III and VI, in order to predict the severity of liver fibrosis._x000D_ 2. To obtain the optimal cut-off point of the IFA value in detecting the severity of liver fibrosis._x000D_ 3. To demonstrate the reproducibility of the IFA measurement by CT._x000D_ 120 consecutive HIV infected and HCV coinfected patients with active viral replication were selected and assessed at the HIV Clinical Unit of the Germans Trias i Pujol University Hospital in Badalona. Anthropometric variables were collected, a blood test was performed, the stage of liver fibrosis was determined by transient elastography and patients were referred to the Radiology Service where they performed the same day an abdominal CT to determine IFA and hepatic steatosis. Quantification of intra-abdominal and subcutaneous fat was carried out with the help of a specific post-processing program. Hepatic steatosis was assessed by obtaining the attenuation coefficient of the liver and spleen. After a first phase of reading and validation of the database, different statistical analyzes were carried out._x000D_ As for the results, we could confirm that the only independent factor associated with stage F2 fibrosis was IFA. Albumin and body mass index (BMI) were associated with F3. The independent predictors of hepatic cirrhosis were albumin concentration and IFA._x000D_ Regarding the diagnostic accuracy of IFA and hepatic steatosis, IFA may be considered useful in the prediction of liver fibrosis, in patients with fibrosis._x000D_ In the diagnosis of cirrhosis, an optimum cutoff point (cm2) for IFA was obtained._x000D_ Regarding reproducibility, no intraobserver variability was observed in the assessment of all variables, nor interobserver in the assessment of IFA, instead, a significant interobserver variability in the assessment of hepatic steatosis was observed._x000D_ In conclusion, this thesis confirms that CT-measured IFA is an independent factor associated with the severity of liver fibrosis in HIV / HCV co-infected patients, that the highest diagnostic accuracy for the prediction of liver cirrhosis is reached in women with a cut-off point of IFA value of 144 cm2 and that the measurement of the IFA by CT is a reproducible technique with little intra and interobserver variability.
Asociación entre el Acúmulo de Grasa Intraabdominal medido por Tomografía Computarizada y la gravedad de la fibrosis hepática en pacientes infectados por el Virus de la Inmunodeficiencia Humana y el Virus de la Hepatitis C
Mª Montserrat Tenesa Bordas (Author). 29 Nov 2017
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis