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. 2024 Apr;27(4):e26238.
doi: 10.1002/jia2.26238.

Metabolic causes of liver disease among adults living with HIV from low- and middle-income countries: a cross-sectional study

Marie Kerbie Plaisy  1 , Albert K Minga  2 , Gilles Wandeler  3 , Gad Murenzi  4 , Niharika Samala  5 , Jeremy Ross  6 , Alvaro Lopez  7 , Ephrem Mensah  8 , Renée de Waal  9 , Mark H Kuniholm  10 , Lameck Diero  11 , Sonali Salvi  12 , Rodrigo Moreira  13 , Alain Attia  14 , Ardele Mandiriri  15 , Fabienne Shumbusho  4 , Suzanne Goodrich  5 , Dhanushi Rupasinghe  16 , Paola Alarcon  7 , Fernanda Maruri  17 , Hugo Perrazo  13 , Antoine Jaquet  1 ; Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS
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Metabolic causes of liver disease among adults living with HIV from low- and middle-income countries: a cross-sectional study

Marie Kerbie Plaisy et al. J Int AIDS Soc. 2024 Apr.

Abstract

Introduction: Liver disease is a leading cause of morbidity and mortality among persons living with HIV (PLHIV). While chronic viral hepatitis has been extensively studied in low- and middle-income countries (LMICs), there is limited information about the burden of metabolic disorders on liver disease in PLHIV.

Methods: We conducted a cross-sectional analysis of baseline data collected between October 2020 and July 2022 from the IeDEA-Sentinel Research Network, a prospective cohort enrolling PLHIV ≥40 years on antiretroviral treatment (ART) for ≥6 months from eight clinics in Asia, Americas, and central, East, southern and West Africa. Clinical assessments, laboratory testing on fasting blood samples and liver stiffness measurement (LSM)/controlled attenuation parameter (CAP) by vibration-controlled transient elastography were performed. Multivariable logistic regression models assessed factors associated with liver fibrosis (LSM ≥7.1 kPa) and steatosis (CAP ≥248 dB/m). Population attributable fraction (PAF) of each variable associated with significant liver fibrosis was estimated using Levin's formula.

Results: Overall, 2120 PLHIV (56% female, median age 50 [interquartile range: 45-56] years) were included. The prevalence of obesity was 19%, 12% had type 2 diabetes mellitus (T2DM), 29% had hypertension and 53% had dyslipidaemia. The overall prevalence of liver fibrosis and steatosis was 7.6% (95% confidence interval [CI] 6.1-8.4) and 28.4% (95% CI 26.5-30.7), respectively, with regional variability. Male sex at birth (odds ratio [OR] 1.62, CI 1.10-2.40), overweight/obesity (OR = 2.50, 95% CI 1.69-3.75), T2DM (OR 2.26, 95% CI 1.46-3.47) and prolonged exposure to didanosine (OR 3.13, 95% CI 1.46-6.49) were associated with liver fibrosis. Overweight/obesity and T2DM accounted for 42% and 11% of the PAF for liver fibrosis, while HBsAg and anti-HCV accounted for 3% and 1%, respectively. Factors associated with steatosis included overweight/obesity (OR 4.25, 95% CI 3.29-5.51), T2DM (OR 2.06, 95% CI 1.47-2.88), prolonged exposure to stavudine (OR 1.69, 95% CI 1.27-2.26) and dyslipidaemia (OR 1.68, 95% CI 1.31-2.16).

Conclusions: Metabolic disorders were significant risk factors for liver disease among PLHIV in LMICs. Early recognition of metabolic disorders risk factors might be helpful to guide clinical and lifestyle interventions. Further prospective studies are needed to determine the causative natures of these findings.

Keywords: HIV acquisition; antiretroviral therapy; liver disease; liver fibrosis; low‐ and middle‐income countries; metabolic disorders.

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Conflict of interest statement

The authors have no competing interests to disclose.

Figures

Figure 1
Figure 1
Study flowchart of PLHIV enrolled in the SRN cohort assessed for liver fibrosis and steatosis at baseline visit.
Figure 2
Figure 2
Prevalence of liver steatosis and fibrosis assessed by transient elastography according to participating sites.
Figure 3
Figure 3
Factors associated with significant liver fibrosis in adults living with HIV on ART.
Figure 4
Figure 4
Factors associated with significant liver steatosis in adults living with HIV on ART.
See this image and copyright information in PMC

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