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. 2023 Aug;135(15-16):420-428.
doi: 10.1007/s00508-022-02133-9. Epub 2022 Dec 28.

Prevalence and dynamics of NAFLD-associated fibrosis in people living with HIV in Vienna from first presentation to last follow-up

Caroline Schwarz  1   2   3 , David Chromy  1   2   4 , David Bauer  1   2   3 , Nikki Duong  5 , Victor Ulrich Schmidbauer  6 , Michael Schwarz  1   2   3 , Mattias Mandorfer  1   2   7 , Armin Rieger  4 , Michael Trauner  1   7 , Michael Gschwantler  3   8 , Thomas Reiberger  9   10   11
Affiliations

Prevalence and dynamics of NAFLD-associated fibrosis in people living with HIV in Vienna from first presentation to last follow-up

Caroline Schwarz et al. Wien Klin Wochenschr. 2023 Aug.

Abstract

Background/aims: Non-alcoholic fatty liver disease (NAFLD) is frequent in people living with HIV (PLWH) and may be aggravated by metabolic comorbidities and antiretroviral therapy (ART)-associated adverse effects.

Methods: We retrospectively assessed epidemiological, clinical and laboratory parameters and ART regimens at HIV diagnosis (BL) and at last follow-up (FU) in 1458 PLWH without viral hepatitis coinfection attending our HIV clinic in 2014-2016. Fibrosis was non-invasively assessed by the NAFLD fibrosis score (NFS).

Results: The median age of subjects was 37.8 years, 77.4% were male and 67.2% on ART, median CD4+ count was 356.0 cells/µL. At BL, 503 (34.5%) and 20 (1.4%) PLWH had dyslipidemia and diabetes, respectively. According to the NFS 16 (1.3%) showed advanced fibrosis (NFS ≥ 0.676), among which 1 (6.3%) had diabetes, 7 (43.8%) had dyslipidemia, and 5 (31.3%) were on HIV-protease inhibitors (PI). In addition, 191(15.1%) had intermediate NFS results, while fibrosis was ruled out (NFS ≤ 1.455) in 1065 (83.7%) PLWH. After a median follow-up of 6.3 years, 590 (42.8%) had dyslipidemia and 61 (4.4%) had diabetes. Also, 21 (1.6%) showed advanced fibrosis, of which 10 (47.6%) had diabetes, 4 (19.0%) had dyslipidemia, and 9 (42.9%) were on PI-based ART, 223 (17.4%) had intermediate NFS results, while 1039 (81.0%) showed no fibrosis.

Conclusion: During FU, advanced NAFLD fibrosis occurred in 1.3-1.6% of PLWH. Dyslipidemia, diabetes, and PI-based ART were associated with advanced NAFLD fibrosis. Prospective investigations of NAFLD severity and risk factors in PLWH are warranted.

Keywords: Epidemiology; Human Immunodeficiency Virus; Metabolic dysfunction associated fatty liver disease; Non-alcoholic Fatty Liver Disease; Protease Inhibitors.

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Conflict of interest statement

C. Schwarz received travel support from Gilead, Abbvie, and Gebro; speakers honoraria from Abbvie and Gilead; and served as a consultant for Gilead. D. Chromy served as a speaker and/or consultant and/or advisory board member for AbbVie, Gilead, and MSD, and received travel support from AbbVie, MSD, ViiV Healthcare, and Gilead. D. Bauer received travel support from Gilead and Abbvie and speaker fees from Abbvie. M. Schwarz received speakers honoraria from BMS and travel support from BMS, MSD, Abbvie and Gilead. M. Mandorfer served as a speaker and/or consultant and/or advisory board member for AbbVie, Bristol-Myers Squibb, Collective Acumen, Gilead, and W. L. Gore & Associates and received travel support from AbbVie, Bristol-Myers Squibb, and Gilead. M. Trauner received grant support from Albireo, Alnylam, Cymabay, Falk, Gilead, Intercept, MSD, Takeda and Ultragenyx, honoraria for consulting from Albireo, Boehringer Ingelheim, BiomX, Falk, Genfit, Gilead, Intercept, MSD, Novartis, Phenex, Regulus and Shire, speaker fees from Bristol-Myers Squibb, Falk, Gilead, Intercept and MSD, as well as travel support from AbbVie, Falk, Gilead and Intercept and is the co-inventor of patents on the medical use of 24-norursodesoxycholic acid. M. Gschwantler received grant support from Abbvie, Gilead and MSD; speakers honoraria from Abbvie, Gilead, Intercept, Janssen, BMS, Roche, Norgine, AstraZeneca, Falk, Shionogi, and MSD; consulting/advisory board fees from Abbvie, Gilead, Intercept, Janssen, BMS, Roche, Alnylam, Norgine, AstraZeneca, Falk, Shionogi and MSD; and travel support from Abbvie and Gilead. T. Reiberger received grant support from Abbvie, Boehringer-Ingelheim, Gilead, MSD, Philips Healthcare, Gore; speakers honoraria from Abbvie, Gilead, Gore, Intercept, Roche, MSD; consulting/advisory board fee from Abbvie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Siemens; and travel support from Boehringer-Ingelheim, Gilead and Roche. N. Duong, V.U. Schmidbauer and A. Rieger declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study population. Assessment of NAFLD-associated advanced fibrosis according to NAFLD fibrosis score (NFS). Percentages were calculated for the subgroup of patients with available NFS. HIV human immunodeficiency virus, HBV hepatitis B virus, HCV hepatitis C virus, NFS NAFLD fibrosis score, FU follow-up
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