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  International Workshop
on HIV and Aging
September 23-24, 2021

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NAFLD Independently Tied to Worse
Physical Quality of Life With HIV

  International Workshop on HIV and Aging, September 23-24, 2021
By Mark Mascolini for NATAP and Virology Education
Analysis of 196 middle-aged US adults with HIV infection independently linked moderate to severe nonalcoholic fatty liver disease (NAFLD) to worse physical quality of life (QOL) [1]. The study also tied older age, black race, and diabetes to worse physical QOL.
NAFLD is the most frequent liver disease in people with HIV. With no medication licensed to treat NAFLD, clinicians can only recommend weight loss (to lower fat, inflammation, and liver fibrosis) or treat contributors to NAFLD like diabetes [2]. In the general population, research ties NAFLD to poor health-related QOL, but no work had addressed the impact of NAFLD on health-related QOL in people with HIV.
To remedy that shortcoming, researchers from the University of Texas at Houston and colleagues at other centers conducted this study of NAFLD and health-related QOL in a diverse population of middle-aged people with HIV. They recruited HIV-positive people from three outpatient clinics and performed vibration-controlled transient elastography to measure controlled attenuation parameter (CAP) and liver stiffness. The researchers defined NAFLD as CAP at or above 285 dB in people without risky alcohol drinking (score below 8 on the AUDIT questionnaire).
Participants also completed the Rand SF-36 QOL assessment, which gauges 8 health-related QOL domains with a score from 0 to 100. A higher score indicates better QOL. The investigators grouped individual health-related QOL domain scores to create a composite physical component score and a composite mental component score.
Of the 196 study participants, 74% were male, 20% cisgender female, and 6% transgender female. Just over half of the group (56%) were white, while 26% were Hispanic; 95% were taking antiretroviral therapy. Testing showed that 40% had NAFLD, and 10% had liver stiffness at or above 8.6 kPa (the threshold for significant liver fibrosis). The group’s QOL physical component averaged 47, while the mental component score averaged 50-both scores reflecting poor QOL.
Compared with people without NAFLD, those with NAFLD were significantly younger (45 vs 48 years), less likely to be nonwhite (31% vs 53%), and more likely to have diabetes (24% vs 5%). Compared with the no-NAFLD group, people with NAFLD had a significantly higher body mass index (32 vs 27 kg/m2), larger waist circumference (112 vs 96 cm), higher ALT liver enzyme (36 vs 25 U/L), higher triglycerides (185 vs 125 mg/L), higher CD4 count (835 vs 690), and lower (worse) physical component QOL score (45 vs 49) (P < 0.05 for all differences). Mental component QOL score was low and similar in people with or without NAFLD (51 and 50).
Multivariate analysis adjusted for age, race, gender, and diabetes status determined that moderate to severe NAFLD (CAP at or above 285 dB) independently predicted worse physical QOL in these people with HIV (beta estimate -3.42, standard error [SE] 1.63, P = 0.04). Three other factors were also associated with worse physical QOL: each additional year of age (beta estimate -0.18, SE 0.06, P = 0.01), black race (beta estimate -6.06, SE 1.72, P < 0.01), and diabetes (beta estimate -5.88, SE 2.35, P < 0.01). NAFLD was not significantly associated with mental QOL.
Given the physical burden of NAFLD in this HIV group (overweight, wide waist, diabetes, and high liver enzymes and triglycerides), it is not surprising that moderate to severe NAFLD is linked to worse physical QOL. The researchers noted it remains to be seen whether management of these physical deficits-including lifestyle changes and exercise-can improve health-related quality of life in people with NAFLD.
1. Gawrieh S, Lake J, Desai A, et al. NAFLD is associated with worse physical quality of life in persons with HIV. International Workshop on HIV and Aging, September 23-24, 2021. Abstract 40.
2. National Institute of Diabetes and Digestive and Kidney Diseases. Nonalcoholic fatty liver disease (NAFLD) & NASH.