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Fatty Liver Disease & Non-Viral Hepatitis in PLWH
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Non-Viral Liver Disease in HIV+ - Increased Prevalence of Liver Fibrosis in PLWH Increased Prevalence of Liver Fibrosis in People Living With Human Immunodeficiency Virus Without Viral Hepatitis Compared to Population Controls - (03/02/21)
Forty-one (12%) of PWH without viral hepatitis had elevated LSM assessed by transient elastography compared to 154 (7%) population controls. The proportion of PWH with mild, moderate, and severe fibrosis was higher compared to population controls (P < .01) (Figure 2). Compared to PWH without elevated LSM, PWH with elevated LSM were older (62 vs 56 years; P < .01), with higher waist circumference (102 vs 93 cm; P < .01), BMI (26 vs 24 kg/m2; P = .02), and AST (31 vs 28 IU/L; P = .02). They were more frequently diabetic (23% vs 5%; P < .01), overweight and obese (56% vs 39%; P = .02), and more frequently had metabolic syndrome (62% vs 40%; P = .02) and hepatic steatosis (27% vs 6%; P < .01)
Non-viral Liver Disease Burden in HIV Mono-infected Individuals: A Prospective Cohort Study - (12/07/17)
NAFLD Management - Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial - (06/9/21)
Tesamorelin & Fatty Liver Disease in HIV - Clinical Predictors of Liver Fibrosis Presence and Progression in HIV-Associated Nonalcoholic Fatty Liver Disease
AASLD: What Are the Current Treatment Options for our Patients with NAFLD/NASH ? - (12/01/20)
Nonalcoholic Fatty Liver Disease and the Development of Metabolic Comorbid Conditions in Patients With Human Immunodeficiency Virus Infection - (08/10/20)
Nonalcoholic fatty liver disease (NAFLD), defined as fat accumulation in the liver in the absence of excessive alcohol consumption, is an epidemic entity affecting approximately 25% of the world’s population [1]. At baseline, the prevalence of NAFLD was 38.1%. Severe hepatic steatosis affected 81 (16.7%) patients. Suspected significant liver fibrosis and cirrhosis affected 72 (14.8%) and 12 (2.5%) of the patients, respectively. Overall, 57 (11.9%) and 102 (21%) patients were exposed to didanosine and stavudine, respectively. The increasing burden of NAFLD in the HIV-infected population, combined with our findings of its impact on metabolic comorbid conditions, indicate that PWH with NAFLD may be at particularly high risk of cardiovascular-associated disease and death. Indeed, cardiovascular events are the leading cause of death in patients with NAFLD, and PWH have higher cardiovascular risk than the general population [39-41]. This is thought to reflect the effects of systemic inflammation and endothelial dysfunction, as well as the disproportionate presence of the established risk factors of insulin resistance and dyslipidemia. In addition, the effect of NAFLD on long-term outcomes in the HIV-infected population is still not completely understood. Importantly, in HIV-uninfected patients with NAFLD, the severity of liver fibrosis affects not only liver-related, but also all-cause mortality rates [39]. As such, guidelines recommend cardiovascular risk stratification for all patients with NAFLD, particularly those with liver fibrosis [42, 43]. Management of NAFLD in HIV infection may include treating modifiable metabolic risk factors, diet and exercise, and nutritional supplements as well as optimizing HIV-related factors and ART [44-46].
Associations of Hepatosteatosis With Cardiovascular Disease in HIV-Positive and HIV-Negative Patients: The Liverpool HIV-Heart Project - (08/15/21)
PLWHIV have unique risk factors for the development of HS compared with non-HIV populations. They have been shown to develop lean NAFLD, defined as NAFLD in BMI <25 kg/m2, at increased rates compared with that in non-HIV populations.7 The complex interplay of viral-related factors, antiretroviral medications, and chronic inflammation may cause PLWHIV to be more susceptible to the development of HS. Liver disease represents a huge source of morbidity and mortality in PLWHIV, with up to 13% of deaths in the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort study attributable to liver disease.8 In both HIV-positive and HIV-negative populations, dyslipidemia, insulin resistance, and overt type II diabetes are strongly associated with the presence of HS.
Metabolic dysfunction-associated fatty liver disease is associated with increased all-cause mortality in the United States - (08/15/21)
MAFLD was diagnosed as the presence of hepatic steatosis with 1 or more of the following: (1) overweight or obese (body mass index ≥ 25 kg/m2) (2) diabetes mellitus (3) at least 2 metabolic risk abnormalities. Metabolic risk abnormalities consisted of (1) waist circumference ≥ 102 cm for men and 88 ≥ cm for women, (2) blood pressure ≥ 130/85 mmHg or specific drug treatment, (3) fasting plasma triglycerides ≥ 150 mg/dl or specific drug treatment, (4) plasma HDL-cholesterol < 40 mg/dl for men and < 50 mg/dl for women or specific drug treatment, (5) prediabetes (fasting glucose 100-125 mg/dl or hemoglobin A1c 5.7%-6.4%, (6) homeostasis model assessment of insulin resistance score ≥ 2.5, (7) plasma high-sensitivity C-reactive protein level > 2 mg/L.[[4]]
EASL: NAFLD Doubles Risk of CVD and Cuts up to 6 Years off Life Expectancy - (06/26/21)
EASL: About 2-Fold Higher Risk of MI, HCC, CKD When NASH Patients Have Cirrhosis - (07/05/21)
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