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Higher Steatosis Risk in HIV+ Hispanics,
But No Link to Integrase Inhibitors
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IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Compared with blacks and whites, HIV-positive Hispanics in a large US clinic ran a higher risk of hepatic steatosis calculated by two formulas [1]. Treatment with integrase inhibitors did not correlate with higher body mass index (BMI) or hepatic steatosis in this analysis, but the study did link protease inhibitor (PI) use to lower steatosis risk.
Recent research ties integrase inhibitor therapy to greater weight gain and visceral adiposity, especially in blacks, Hispanics, and women. Other work links steatosis to higher atherosclerotic cardiovascular disease risk in the general population. But because no research explores potential associations between integrase inhibitors and hepatic steatosis, a Dallas team undertook this study.
The analysis included all adults on a stable antiretroviral regimen at a single large Dallas clinic. Researchers calculated hepatic steatosis index (HSI) in all people and controlled attenuation parameter (CAP) score in a subset of people who had transient elastography of their liver. They used linear regression models adjusted for age to analyze the impact of antiretroviral class, race, and ethnicity on HSI and CAP.
The study group included 3122 people with HIV, 85% of them men, 45% black, 22.5% Hispanic, and 30% non-Hispanic white. Age averaged 42. While 1777 participants took an integrase inhibitor, 723 took a PI and 302 a nonnucleoside (NNRTI).
Average BMI did not differ significantly between people taking an integrase inhibitor (27.87 kg/m2), a PI (27.0 kg/m2), or an NNRTI (28.26 kg/m2). But HSI proved significantly lower in the PI group (35.99) than the integrase inhibitor group (36.73) or the NNRTI group (37.46) (P = 0.02).
HSI was significantly higher among Hispanics (37.54) than among non-Hispanic blacks (36.56) or whites (36.19) (P = 0.001). HSI correlated strongly with CAP (R = 0.45, P < 0.001), and CAP tended to be higher in Hispanics than in blacks or whites (P = 0.11). Older age predicted higher HSI (P < 0.01). HSI-determined hepatic steatosis correlated positively with atherosclerotic cardiovascular disease risk score--the higher the HSI, the higher the cardiovascular risk (R = 0.1, P < 0.001).
The researchers proposed that the positive correlation between HSI and atherosclerotic cardiovascular disease risk score suggests hepatic steatosis in people with HIV may predict cardiovascular risk.
Reference
1. Bedimo R, Gillman J, Ayers C, et al. Hepatic steatosis in people living with HIV--effect of sex and race/ethnicity. IDWeek, October 2-6, 2019, Washington, DC. Abstract 347.
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