Relationship between phase angle, steatosis, and liver fibrosis in patients coinfected with human immunodeficiency virus/hepatitis C virus

Sabrina Alves Fernandes; Cristiane Valle Tovo; André Luiz Machado da Silva; Letícia Pereira Pinto; Randhall B Carteri; Angelo A Mattos

doi:10.4254/wjh.v14.i6.1173

Relationship between phase angle, steatosis, and liver fibrosis in patients coinfected with human immunodeficiency virus/hepatitis C virus

World J Hepatol. 2022 Jun 27;14(6):1173-1181. doi: 10.4254/wjh.v14.i6.1173.

Authors

Sabrina Alves Fernandes¹, Cristiane Valle Tovo², André Luiz Machado da Silva³, Letícia Pereira Pinto¹, Randhall B Carteri⁴, Angelo A Mattos¹

Affiliations

¹ Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil.
² Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil. cristianev@ufcspa.edu.br.
³ Department of Infectology Service, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, Brazil.
⁴ Department of Nutrition, Centro Universitário Metodista-IPA, Porto Alegre 90420-060, Brazil.

Abstract

Background: Malnutrition, lipodystrophy, and dyslipidemia are prevalent characteristics in patients with human immunodeficiency virus (HIV) infection with or without previous treatment. Such a clinical condition can lead to the hypothesis of the presence of hepatic steatosis with possible progression to fibrosis and the risk of hepatocellular carcinoma. Notably, a low phase angle (PA), evaluated by bioelectrical impedance analysis (BIA), is an independent prognostic marker of clinical progression and survival in HIV-infected patients.

Aim: To evaluate the relationship between PA and body composition with steatosis and hepatic fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients.

Methods: A retrospective observational study by convenience sampling of coinfected HIV/HCV patients, in which all patients underwent transient elastography (Fibroscan) and BIA evaluation. Student's t test was used for group comparisons, and Spearman's or Pearson's correlation test was used when appropriate. The significance level was set at 5%, and analyses were performed using SPSS version 21.0.

Results: Forty-three patients who received antiretroviral therapy met the inclusion criteria, and 23 (53.5%) were under treatment with protease inhibitors (PIs). There was no difference in PA between those who used PIs and those who did not (P = 0.635). There was no correlation between fibrosis grade and PA (P = 0.355) or lean mass (P = 0.378). There was a significant inverse correlation between the controlled attenuation parameter (CAP) and lean mass (P = 0.378), positive correlation between PA and lean mass (P = 0.378), and negative correlation between PA and fatty mass (P = 0.378), although the CAP and PA were not correlated. When evaluated by sex, no significant correlations were found.

Conclusion: PA determines the muscle function of HIV/HCV-coinfected patients, and the CAP values reinforce the association with lean mass, suggesting that patients require early nutritional interventions.

Keywords: Bioelectrical impedance; Coinfection; Hepatitis C virus; Human immunodeficiency virus; Nutrition; Phase angle.