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Nonalcoholic Fatty Liver in One Third of Naval Center Patients With HIV
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48th ICAAC, October 25-28, 2008, Washington, DC
Mark Mascolini
Nonalcoholic fatty liver disease (NAFLD) affected one third of HIV-infected people without hepatitis virus coinfection at the Naval Medical Center in San Diego [1]. That prevalence lies at the upper end of NAFLD rates seen in the US general population (17% to 33%), according to the investigators. Central obesity and abnormal lipids inflated the risk of NAFLD, but HIV-specific factors including antiretroviral therapy did not.
This cross-sectional study of HIV-infected people sought to establish the rate of NAFLD and risk factors for the condition in people not coinfected with a hepatitis B or C virus. Study participants were all military beneficiaries--including people on active duty, retirees, and dependents--enrolled between January 2006 and June 2007. The study excluded anyone with self-reported heavy alcohol use, defined as more than 140 g of weekly for men and more than 70 g weekly for women.
All 216 study participants underwent liver ultrasound. Only 12 (5.5%) were women, 103 (47.7%) were white, 59 (27.3%) were African American, and 54 (25.0%) belonged to other racial or ethnic groups. Sixty-three people (29.2%) were taking lipid-lowering drugs, 49 (22.7%) were taking antihypertensives, and 32 (14.8%) had a body mass index at or above 30 kg/m(2). Body mass index averaged 26.0 (+/-) 4.1 kg/m(2) and waist circumference averaged 90.4 (+/- 11.9) cm.
HIV infection duration averaged 10 years, nadir CD4 count 295, and current CD4 count 535. Half of the study group had a viral load under 50 copies, and 156 (72.2%) were taking antiretrovirals, including 121 (56.0%) taking a protease inhibitor, 88 (40.7%) taking stavudine, and 67 (31.0%) taking didanosine. Triglycerides averaged 172 mg/dL, and 55 people (25.6%) had at least one liver test abnormality.
The investigators detected ultrasound-diagnosed NAFLD in 67 people (31%), finding mild hepatic steatosis in 40 (60% of the 67), moderate steatosis in 19 (28%), and marked or severe steatosis in 8 (12%). Among 55 people who had a liver biopsy, 20 (36%) had biopsy-confirmed NAFLD.
Multivariate analysis considering demographics, body composition, concurrent antiretrovirals and other medications, HIV factors, lipids, and liver function tests found that African Americans had a 60% lower risk of NAFLD than whites (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2 to 1.0, P = 0.05). Every additional 10 cm of waist circumference independently doubled the risk of NAFLD (OR 2.1, 95% CI 1.6 to 2.8, P < 0.001). Every 100 mg/dL higher triglyceride reading upped the NAFLD risk 20% (OR 1.2, 95% CI 1.0 to 1.5, P = 0.03). And lower "good" high-density lipoprotein cholesterol made NAFLD 30% less likely (OR 0.7, 95% CI 0.5 to 1.0, P = 0.04).
Antiretroviral therapy in general, protease inhibitors as a group, and stavudine or didanosine individually did not affect the risk of NAFLD. Neither did any of the other HIV-related variables considered--years of HIV infection, prior opportunistic infection, nadir or current CD4 count, or viral load below 50 copies.
The researchers believe their findings suggest that "weight and lipid management may be key factors for the prevention of liver disease due to NAFLD" in HIV-infected people.
How closely these findings apply to other US HIV populations is hard to say. Many poor people with HIV undoubtedly lack one advantage of the Naval group--regular access to free medical care.
Reference
1. Crum-Cianflone N, Dilay A, Collins G, et al. Nonalcoholic fatty liver disease (NAFLD) among HIV-infected persons. 48th Annual International Conference on Antimicrobial Agents and Chemotherapy (ICAAC). October 25-28, 2008. Washington, DC. Abstract H-2322.
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