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PREVALENCE AND FACTORS ASSOCIATED WITH NAFLD IN PEOPLE WITH HIV
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- Of HIV-specific factors, only exposure to stavudine, INSTI, and current CD4+ and CD8+ T cell counts were associated to steatosis.
- Liver steatosis and fibrosis affect nearly one in two and one in ten PLHIV in this cohort, respectively.
- NAFLD was most strongly associated with traditional NAFLD risk factors.
CROI 2023 Feb 2023
Louise E. van Eekeren1, Marc J. T. Blaauw1, Nadira Vadaq1, Vasiliki Matzaraki1, Wilhelm A. J. W. Vos1, Albert L. Groenendijk1, Adriana Navas1, Gert Weijers1, Mike van Der Kolk2, Andre J.A.M. van Der Ven1, Quirijn De Mast1, Leo Joosten1, Eric Tjwa1 2000HIV
Radboud University Medical Center, Nijmegen, Netherlands, 2ViiV Healthcare, Brentford, United Kingdom
Background: Non-alcoholic fatty liver disease (NAFLD) in people living with HIV (PLHIV) may be more common than in the general population. Screening recommendations for NAFLD in PLHIV are based on guidelines for the general population, not considering HIV-specific factors contributing to NAFLD. In this study, we assessed the prevalence of liver steatosis and fibrosis in PLHIV and explored associations with demographic-, metabolic-, environmental-, and HIV-specific factors, including antiretroviral therapy (ART).
Methods: In the 2000HIV-study (clinicaltrials NTC03994835), 1895 virally suppressed PLHIV were included in 4 Dutch HIV treatment centers. Transient elastography was performed for the assessment of liver steatosis (controlled attenuation parameter, CAP) and fibrosis (liver stiffness measurement, LSM). Demographics, metabolic comorbidities, laboratory assessments including lipid profile and liver function tests, HIV-characteristics, and current and cumulative exposure to ART regimens, were tested in univariable (demographic factors) and multivariable (other factors) logistic regression models for association with steatosis and fibrosis.
Results: Data from 1075 PLHIV showed steatosis in 47.5% [95% CI: 44.4 - 50.6] and fibrosis in 8.8% [7.1 - 10.6].
Age (per decade, odds ratio (OR) 1.49, 95% CI [1.33-1.66], P-value < 0.001, and OR 1.12 [0.93-1.34], P-value = 0.356, respectively ) and subcutaneous fat layer thickness ( 25 mm2 vs > 25 mm2., OR 5.16 [3.90-6.83], P-value < 0.001, and OR 2.72 [1.69-4.39], P-value < 0.001, respectively) were significantly associated with steatosis or fibrosis and included in subsequent regression models as covariates.
Traditional metabolic risk factors, e.g. diabetes mellitus type 2 (adjusted OR (aOR) 1.95 [1.02-3.71], P-value = 0.043, and aOR 3.29 [1.64-6.62], P-value = 0.001, respectively), were most strongly associated with both steatosis and fibrosis. In addition, steatosis was associated with current CD4+ and CD8+ T cell counts, cumulative exposure to integrase strand transfer inhibitors (INSTI) in general and raltegravir specifically, and to the nucleoside analogue stavudine.
Conclusion:
- Liver steatosis and fibrosis affect nearly one in two and one in ten PLHIV in this cohort, respectively.
- NAFLD was most strongly associated with traditional NAFLD risk factors.
- Of HIV-specific factors, only exposure to stavudine, INSTI, and current CD4+ and CD8+ T cell counts were associated to steatosis.
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