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. 2023 Dec 15;77(12):1687-1695.
doi: 10.1093/cid/ciad433.

Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis With Liver Fibrosis as Predictors of New-Onset Diabetes Mellitus in People With HIV: A Longitudinal Cohort Study

Win Min Han  1   2   3 , Tanakorn Apornpong  1 , Hay Mar Su Lwin  1 , Siwat Thammapiwan  1 , Jedsadakorn Boonrungsirisap  1 , Sivaporn Gatechompol  1   3 , Sasiwimol Ubolyam  1   3 , Pisit Tangkijvanich  4 , Stephen J Kerr  1   2   5 , Anchalee Avihingsanon  1   3
Affiliations

Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis With Liver Fibrosis as Predictors of New-Onset Diabetes Mellitus in People With HIV: A Longitudinal Cohort Study

Win Min Han et al. Clin Infect Dis. .

Abstract

Background: We investigated the association between nonalcoholic fatty liver disease (NAFLD) plus or minus a concurrent diagnosis of nonalcoholic steatohepatitis (NASH) and incident diabetes mellitus (DM) and the risk factors associated with NAFLD or NASH development.

Methods: In this prospective study, we analyzed people with human immunodeficiency virus (HIV; PWH) aged ≥18 years without excessive alcohol consumption or hepatitis coinfections. NAFLD was defined as controlled attenuation parameter ≥248 dB/m, whereas NASH with significant disease activity and liver fibrosis was defined as a FibroScan-AST score ≥0.67. Cox proportional hazard regression was used to investigate the association between NAFLD with or without NASH and new-onset DM.

Results: Of 847 PWH, the median age at baseline was 45 years (interquartile range, 38-51; 43% female). Baseline NAFLD was associated with 2.8-fold higher risk of new-onset DM after adjusting for age, sex, family history of DM, antiretroviral therapy duration, smoking, statin use, stavudine/didanosine/zidovudine exposure, time-updated body mass index, hypertension, and dyslipidemia. Combined NAFLD and NASH at baseline had 3.1-fold higher new-onset DM risk. In separate analyses, baseline DM did not predict progression to NAFLD or NASH, but tenofovir alafenamide use was associated with an increased risk of NAFLD (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.02-4.02) or NASH development (2.31; 95% CI, 1.12-5.11).

Conclusions: NAFLD alone or combined with NASH strongly predicts new-onset DM. This highlights the need for systematic risk assessments and management of NAFLD/NASH, as it may contribute to metabolic complications such as DM and subsequent cardiovascular diseases in PWH.

Keywords: FibroScan-AST score; HIV; diabetes mellitus; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis.

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Conflict of interest statement

Potential conflicts of interest. A. A. reports grants and contracts from Gilead Sciences, ViiV Healthcare/GSK, and MSD and honoraria for lectures, presentations, speakers’ bureaus, and educational events from Gilead Sciences, ViiV Healthcare, and Abbott Laboratories. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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