Association of HIV infection, hepatitis C virus infection, and metabolic factors with liver stiffness measured by transient elastography

Abstract

Background: Few studies have examined the relationship of human immunodeficiency virus (HIV) monoinfection and its associated perturbations with liver fibrosis.

Methods: USING multivariable linear regression, we examined the demographic, behavioral, metabolic and viral factors associated with transient elastography-measured liver stiffness in 314 participants (165 HIV positive/hepatitis C virus [HCV] negative, 78 HIV positive/HCV positive, 14 HIV negative/HCV positive, 57 HIV negative/HCV negative) in the Women's Interagency HIV Study.

Results: Compared with HIV negative/HCV negative women, HIV positive/HCV positive women had higher median liver stiffness values (7.1 vs 4.4 kPa; P < .001); HIV positive/HCV negative and HIV negative/HCV negative women had similar liver stiffness values (both 4.4 kPa; P = .94). HIV/HCV coinfection remained associated with higher liver stiffness values (74% higher; 95% confidence interval [CI], 49-104) even after multivariable adjustment. Among HCV positive women, waist circumference (per 10-cm increase) was associated with 18% (95% CI, 7.5%-30%) higher liver stiffness values after multivariable adjustment; waist circumference showed little association among HIV positive/HCV negative or HIV negative/HCV negative women. Among HIV positive/HCV negative women, history of AIDS (13%; 95% CI, 4% -27%) and HIV RNA (7.3%; 95% CI, 1.59%-13.3%, per 10-fold increase) were associated with greater liver stiffness.

Conclusions: HCV infection but not HIV infection is associated with greater liver stiffness when infected women are compared with those with neither infection. Our finding that waist circumference, a marker of central obesity, is associated with greater liver stiffness in HIV/HCV-coinfected but not HIV-monoinfected or women with neither infection suggests that in the absence of HCV-associated liver injury the adverse effects of obesity are lessened.

Keywords: HCV; HIV; liver fibrosis; obesity; transient elastography; women.

Figure 1.

Median transient elastography–measured liver stiffness values by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) status. Abbreviations: HCV⁺, HCV positive; HCV⁻, HCV negative; HIV⁺, HIV positive; HIV⁻, HIV negative.

Figure 2.

Association of waist circumference with liver stiffness values by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) status. Abbreviations: HCV⁺, HCV positive; HCV⁻, HCV negative; HIV⁺, HIV positive; HIV⁻, HIV negative.