However, biopsy-based studies with this design will not be easily feasible, given the invasive nature of the technique and the necessity of repeated measures over short periods. Only sequential evaluations of HS with an accurate noninvasive technique can allow these studies. Metabolic factors are associated

with HS. Obesity is a well-characterized risk factor for HS. However, its role in HIV/HCV-coinfected patients seems to be weaker. BMI has been related with HS in cross-sectional studies2-4, 10 and in the only longitudinal study reported so far,15 but the magnitude of this association was small in cross-sectional studies.12 In our study, BMI was not related with progression of HS. One possible Pifithrin-�� purchase reason for the lack of association in our study is that very few patients were overweight or

obese. Indeed, the majority of patients were within the limits of normal BMI. IR plays a central role in metabolic syndrome and it is another factor implicated in HS. In this regard, we found that FPG was associated with HS progression. Several previous cross-sectional studies found an association between fasting glucose and HS.4, 6, 11 However, hypertriglyceridemia, another component of metabolic syndrome, was not associated with HS progression in the present study. In this regard, a meta-analysis carried out in cross-sectional studies on HIV/HCV-coinfected patients failed to show a relationship of hypertriglyceridemia with HS.12 Persistent steatohepatitis or progression to steatohepatitis was observed in 18% LY2157299 cost of patients. This is a high rate of steatohepatitis, which is within the range observed in morbid obesity or DM.13 Our results are in agreement with a previous cross-sectional study on HIV/HCV coinfection that reported on a prevalence of steatohepatitis similar

MCE公司 to the frequencies observed in the herein reported study.5 Notably, we found that persistent steatohepatitis or progression to steatohepatitis was associated with fibrosis progression in sequential biopsies. This result is in agreement with studies in paired liver biopsies among HIV-uninfected patients with NAFLD, where fibrosis progression was observed in the subset of individuals with steatohepatitis.24, 25 Moreover, cohort studies on NAFLD show that patients with steatohepatitis progress to more-serious liver disease and have higher liver-related mortality than those only with HS.26, 27 HS is very frequent in HIV/HCV-coinfected patients.1-12 HS has been linked with fibrosis progression in previous cross-sectional studies on HIV/HCV coinfection2-7 and in the only previous study on paired biopsies.15 Thus, HS itself is relevant in the setting of HIV and HCV dual infection. Because of this, steatohepatitis was a secondary endpoint in the present study. We did not find a correlation between HS and fibrosis progression, in agreement with some cross-sectional studies.