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hepatic steatosis in untreated hiv

Posted: Sep 23, 2007

QUESTION:

I have a 30 yo male patient, diagnosed in 2005, ART naive with cd4 400's in 4/07. Came for f/up in 9/07 had 6lb weight loss, ast 100, ALt 200, hypogonadal, and cd4 count 200(16). Hep B immune, Hep C neg times 2, Hep A neg, LDH normal, RPR NR. I did an abdml CT, which showed diffuse top normal lymph nodes and moderate hepatic steatosis. I am thinking this may all be HIV related. My plan is to start ART. Do you think I am missing anything. I was thinking of starting atripla -he has no resistance.


  

RESPONSE FROM:   

    I agree with your plan. Even HIV uninfected people can get NASH (non-alcoholic steatohepatitis) but there may be more going on here in this man. Screening for diabetes should also be considered, if not already done.

    Atripla is a good choice as it should not cause an increase in liver fat and is not too bad when it comes to lipids.

    Testosterone should also be considered if he has an inappropriately low level.

    DW




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