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Absence of liver steatosis in HIV-infected patients receiving tenofovir-containing regimen

Purpose of the study

Liver steatosis is a common and important histological finding in hepatitis C, and is associated with an increased progression of the disease. In HIV co-infected patients, steatosis was independently associated with d-drugs, such as stavudine, especially in non-3 HCV genotypes. We investigate the safety of tenofovir disoproxil fumarate (TDF) in determining hepatic steatosis in HIV/HCV co-infected patients.


All consecutive HCV-infected patients who had undergone a liver biopsy have been included in this study. Primary outcomes were the presence or absence of steatosis, or the presence of fibrosis.

Summary of results

370 HCV-infected patients underwent liver biopsy; 182 co-infected with HIV. Steatosis (>5% in liver biopsy) was diagnosed in 33.0% of HCV mono-infected and in 47.3% in HIV co-infected patients (OR 1.82; p = 0.005). Fifty HIV patients (27.5%) were naïve to antiretroviral therapy. Eighty-nine patients received stavudine for a median of 38 months (IQR 17.5–58), while 36 patients received tenofovir for a median of 23 months (IQR 8.8–32). Factors associated with steatosis were: genotype 3 (OR 3,14; p < 0.001), presence of fibrosis (OR 1.91; p = 0.039), duration of HCV infection (OR 1.10; p = 0.001) and use of d4T in HIV patients (OR 3.00; p = 0.021). Considering only patients with genotype 3, duration of HCV infection (OR 1.19; p = 0.001) and HCV RNA levels (OR. 1.04; p = 0.039) were the only determinants of steatosis. In HCV genotype other than 3 the risk of steatosis was related to fibrosis (OR 3.95; p = 0.002), use of d4T (OR 4.98; p = 0.014) and older age (OR 1.09; p = 0.014). In all cases use of TDF was not associated with steatosis.


As previously described, the risk of steatosis is mainly associated to HCV genotype 3 in patients infected by HCV. HIV co-infected patients with genotype other than 3 are at risk of developing steatosis with stavudine but not with tenofovir.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Borghi, V., Mussini, C., Manzini, L. et al. Absence of liver steatosis in HIV-infected patients receiving tenofovir-containing regimen. JIAS 11 (Suppl 1), P273 (2008).

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