Effect of the treatment of hepatitis C with interferon (IFN) and ribavirin (RBV) in body composition measurement by DEXA in HIV‐HCV infected patients

摘要

Purpose of the study HIV infection and antiretroviral therapy (ART) have been associated with lipodystrophy (LD), but we unknown the effect of IFN/RBV on the body composition, mainly body fat, in HIV patients, already with a degree of LD. Our objective: to assess the body composition in HIV‐HCV patients that start treatment with IFN/RBV and the changes at its ending. Material and Methods Pilot and prospective study of HIV‐HCV patients. We performed (baseline and at the end of treatment) clinical and laboratory parameters, HIV and HCV‐related. Total and regional body fat contents were measured in the same periods with DEXA (dual‐energy X‐ray absorptiometry) scanners. For LD diagnostic we used the definition of fat/mass ratio (FMR): absence, 1.5, and between 1–1.5 it could have LD but is better to see the evolution. Data are expressed in median. Results We included 10 male patients; age 45 yo; time on ART 115 months. HIV VL 3. Genotype 1 in 8, and 3 in 2. Time on IFN/RBV: 10 months. At the end of the treatment we observed a decrease in the level of total, HDL and LDL‐cholesterol (expressed in percentage: 4, 16 and 1.5 respectively) and a slightly increase in the level of TGR (9%). The total body mass decreased 7% (from 76.2 kg to 70.6), the total body fat decreased 18.4% (from 21.060 g to 17.172) and the total lean mass decreased only 3%. Results expressed in percentage and by regional parts, we observed also a decrease in all the parameters: 11% in total body fat (from 26.3 to 23.4), 6% in the fat in arms (21.9 to 20.5), 10% in total fat in legs (22.5 to 20.3) and 12.5% in total trunk fat (30.3 to 26.5). The FMR also decreased from 1.5 to 1.4. Conclusions Trend to LD at baseline, as the FMR was 1.5. After 10 months on treatment with IFN/RBV there was a decrease in the total body mass (7%), mainly due to the loss of total body fat and less in the lean mass. Regarding the percentage of fat loss, we observed the biggest decrease in the trunk fat and the lesser in the limb fat. So, the FMR also decreased. This effect does not get worse the baseline LD; on the contrary it improves it, although very slightly (decrease of 0.1 in FMR), and could serve to advise the patients and not to be afraid of a possible worsening of LD. The study is ongoing and the next objective will be to perform DXA one year after the end of treatment and to expand the cohort to study clinical or laboratory factors related with these results.