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. 2021 Apr 1;86(4):463-472.
doi: 10.1097/QAI.0000000000002585.

Incident Liver Cirrhosis, Associated Factors, and Cardiovascular Disease Risks Among People Living With HIV: A Longitudinal Study

Win Min Han  1   2 , Thornthun Ueaphongsukkit  1   3 , Pairoj Chattranukulchai  4 , Sarawut Siwamogsatham  5 , Roongruedee Chaiteerakij  6   7 , Jiratchaya Sophonphan  1 , Sivaporn Gatechompol  1   8 , Sasiwimol Ubolyam  1 , Supalak Phonphithak  1 , Kiat Ruxrungtham  1 , Pisit Tangkijvanich  9 , Yingyos Avihingsanon  10 , Stephen J Kerr  1   2   11 , Anchalee Avihingsanon  1   8
Affiliations

Incident Liver Cirrhosis, Associated Factors, and Cardiovascular Disease Risks Among People Living With HIV: A Longitudinal Study

Win Min Han et al. J Acquir Immune Defic Syndr. .

Abstract

Objectives: We investigated the incidence and associated factors of liver cirrhosis and cardiovascular disease risks among people living with HIV (PLHIV) in a Thai cohort.

Design: A prospective cohort analysis.

Methods: Participants with at least one reliable transient elastography measurement during follow-up, who had pretreatment alanine transaminase, AST, and platelet count at HIV treatment initiation were included. Liver cirrhosis was defined as AST to Platelet Ratio Index >1.5 or fibrosis-4 (FIB-4) >3.25 or liver stiffness by transient elastography >12.5 kPa and confirmed by imaging or liver biopsy. Competing-risk regression was used to identify factors associated with liver cirrhosis. Time-updated 10-year atherosclerotic CVD (ASCVD) risks were compared between PLHIV with or without liver cirrhosis.

Results: A total of 1069 participants (33% women, 9% hepatitis C virus, and 16% hepatitis B virus) with the median age and CD4 at cART initiation of 32 years and 240 cells/mm3 were included. During 8232 person-years, 124 (12%) developed liver cirrhosis after a median of 6.9 (2.4-13.7) follow-up years [incidence, 1.5 (95% confidence interval: 1.3 to 1.8) per 100 person-years]. In multivariable analysis, the factors independently associated with liver cirrhosis were time-updated HIV viremia, hepatitis B virus, and hepatitis C virus coinfection, diabetes mellitus, high-density lipoproteins <40 mg/mL, and d4T exposure. The median time-updated 10-year ASCVD risk score was statistically higher among cirrhotic PLHIV vs. noncirrhosis [4.9% (interquartile range, 2.3-9.7) vs. 2.4% (interquartile range, 1.3-4.9), P < 0.001].

Conclusion: PLHIV with metabolic diseases were more likely to develop liver cirrhosis, independent of hepatitis coinfections, and ASCVD risks were higher among cirrhotic individuals.

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Conflict of interest statement

K.R. has served as a consultant for Merck and Tibotec. He has had paid speaking engagements with Bristol Meyers Squibb, Merck, Roche, Janssen-Cilag, GlaxoSmithKline, and GPO. K.R. is also a senior researcher scholar, Thai Research Fund (TRF) and an advisor to the National Research University Project of Commission of Higher Education (CHE) and the Ratchadaphisek Somphot Endowment Fund (HR1161A). P.T. received the fund from the Thailand Research Fund (TRF) Senior Research Scholar (RTA6280004), Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University. T.U. is supported by Second Century Fund (C2F), Chulalongkorn University. The remaining authors have no conflicts of interest to disclose.

References

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