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Diabetese Melitus and Steatohepatitis in pateient on D4T,3TC and EFV Posted: May 11, 2007 QUESTION: In a setting where treatment options are limited as in resource constrained countries how would you approach the case of a poorly controlled diabetic lady on Insulin as well as a HAART regimen comprising D4T, 3TC and EFV for the last 22 months and now having cirrhotic liver from NASH(non alcoholic steatohepatitis. Please also comment on the etiology of the condition and management thereof with specific reference to this case.


RESPONSE FROM: Like you, I am concerned that the d4T can be contributing to this patient's fatty liver disease. How this happens is unclear and may be related to d4T mediated increases in lipids, especially triglycerides and/or direct effects on liver cells. If AZT or tenofovir are available, I would consider substituting one of these for the d4T. A low sweet diet and complete absteinance from alcohol is also important. Some data suggest that rosiglitazone and perhaps pioglitazone can reduce fatty liver in HIV. Pioglitazone may be safer and if available is another option. DW

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