Clinical, biochemical and histological differences between HIV-associated NAFLD and primary NAFLD: a case-control study.

BACKGROUND: There are limited data regarding the clinical, biochemical and liver histological characteristics of patients with HIV-associated nonalcoholic fatty liver disease (NAFLD), and whether this entity differs in presentation and severity from primary NAFLD AIM: To examine the clinical and histological differences between HIV-associated NAFLD and primary NAFLD. METHODS: This is a cross-sectional, case-control study comparing patients with HIV-associated NAFLD vs. patients with primary NAFLD. HIV-infected patients were identified from a database of consecutive liver biopsies performed at the University of California at San Diego, over a 13-year period. HIV-infected patients with biopsy-proven NAFLD were selected as cases, after exclusion of other causes of liver disease and hepatic steatosis. Age-sex-matched controls with biopsy-proven primary NAFLD were randomly identified from the same pathology database. All biopsies underwent a standardised, detailed, histological research evaluation by a liver pathologist who was blinded to clinical and case-control status. RESULTS: Compared to age-sex-matched patients with primary NAFLD (n = 33), patients with HIV-associated NAFLD (n = 33) had significantly higher mean aspartate aminotransferase (P < 0.001), alanine aminotransferase (P < 0.001), alkaline phosphatase (P = 0.003) and serum triglycerides (P = 0.024). Similarly, compared to age-sex-matched primary NAFLD, patients with HIV-associated NAFLD had significantly higher rates of definite steatohepatitis (37% vs. 63%, P = 0.04), and more features of liver injury, including lobular inflammation (<0.001) and acidophil bodies (<0.001). CONCLUSION: Compared to age-sex-matched primary NAFLD, HIV-associated NAFLD has increased severity of liver disease and a higher prevalence of NASH.

Management of Hepatitis B virus infection during pregnancy.

Hepatitis B virus (HBV) infects over 2 billion people worldwide, with approximately 360 million chronically infected. It results in substantial morbidity and mortality, with an estimated 600,000 deaths per year. In endemic areas, mother to child transmission (MTCT) is the most important source of new infections, but even in areas with low endemicity, over 1/3 of infections can still be attributed to this route. Although very effective active-passive immunoprophylaxis with hepatitis B immune globulin (HBIG) and HBV vaccine is available, even with full compliance, failure can be seen in highly viremic mothers who are positive for hepatitis B e antigen. Potential means of reducing the risk of MTCT include nucleotide/nucleoside antiviral agents, interferon in very select cases, and mode of delivery. Determining the optimal therapy and its timing, and preventing both obstetric and liver related complications remains a challenge, but is also an important opportunity to reduce chronic hepatitis B infection. In this review, we provide an overview of issues associated with hepatitis B and its treatment during pregnancy, and suggest an algorithm for management.