Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 7;7(1):ofz509.
doi: 10.1093/ofid/ofz509. eCollection 2020 Jan.

Presumed Nonalcoholic Fatty Liver Disease Among Medicare Beneficiaries With HIV, 2006-2016

James M Paik  1 , Linda Henry  2 , Pegah Golabi  1 , Saleh A Alqahtani  3 , Gregory Trimble  4 , Zobair M Younossi  1   4
Affiliations

Presumed Nonalcoholic Fatty Liver Disease Among Medicare Beneficiaries With HIV, 2006-2016

James M Paik et al. Open Forum Infect Dis. .

Abstract

Background: Newer treatments for HIV and hepatitis C virus (HCV) have decreased mortality in HIV/HCV patients. Nonalcoholic fatty liver disease (NAFLD) has increased globally; therefore, the prevalence and mortality of NAFLD among HIV (+) patients was assessed.

Methods: Using Medicare denominator, inpatient, and outpatient files (random 5% sample per year), serial cross-sectional analysis (2006 to 2016) was performed. Joinpoint trend analysis evaluated prevalence and mortality with average annual percent change (AAPC). HIV (+) patients and liver diseases (LDs) were identified using International Classification of Diseases 9/10 codes. NAFLD was presumed using diagnosis codes or codes for metabolic dysfunction and obesity in absence of other LDs. Liver-related HIV (+) indicated HIV (+) patients with LDs.

Results: Among 28 675 887 Medicare beneficiaries, 47 062 were HIV (+) (mean [SD] age, 51.4 [11.3] years); 11 920 had liver diseases (6923 HCV, 2019 hepatitis B virus [HBV], 2472 presumed NAFLD, 278 alcoholic liver disease [ALD], and 1653 other LDs); 2882 HIV (+) patients died; 1260 had LDs. The prevalence and mortality for non-liver-related HIV (+) decreased (AAPC, -1.1% and -9.1%). Liver-related HIV (+) increased (AAPC, 1.7%; P = .007); mortality leveled off. Prevalence and mortality worsened for presumed NAFLD (AAPC, 9.7% and 10.0%) and improved for HBV and HCV (HBV: AAPC, -3.5% and -8.8%; HCV: AAPC, -0.7% and -4.9%). After adjustments, HCV (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.24-172), HBV (OR, 2.40; 95% CI, 2.09-2.77), ALD (OR, 5.70; 95% CI, 4.34-7.48), and presumed NAFLD (OR, 1.46; 95% CI, 1.24-1.72) increased 1-year mortality.

Conclusions: Among HIV (+) subjects, viral hepatitis remains the leading LD for increased 1-year mortality, but the prevalence and mortality with presumed NAFLD are increasing.

Keywords: HBV; HCV; liver disease; mortality; trends.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow diagram of the study cohort. Abbreviations: ALD, alcoholic liver disease; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.
Figure 2.
Figure 2.
Prevalence and mortality rates for HIV+ Medicare patients with/without liver disease from 2006 to 2016. Abbreviations: AAPC, average annual percent change; APC, annual percent change.
Figure 3.
Figure 3.
Prevalence and mortality rates for HIV+ Medicare patients with nonalcoholic fatty liver disease, hepatitis C virus, and hepatitis B virus from 2006 to 2016. Abbreviations: AAPC, average annual percent change; APC, annual percent change; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. HIV at a glance. 2018. Available at: https://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed 1 October 2019.
    1. Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 2017; 4:e349–56. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2013. HIV Surveillance Supplemental Report 2015; 20(No. 2). 2015. Available at: http://www.cdc.gov/hiv/library/reports/surveillance. Accessed 1 October 2019.
    1. Centers for Disease Control and Prevention. HIV prevention in the United States. New opportunities. New expectations. Available at: https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-prevention-bluebook.pdf. Accessed 10 January 2019.
    1. Kang W, Tong H-I, Sun Y, et al. Hepatitis C virus infection in patients with HIV-1: epidemiology, natural history and management. Expert Rev Gastroenterol Hepatol 2014; 8:247–66. - PubMed