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. 2024 Dec;25(12):1308-1324.
doi: 10.1111/hiv.13730. Epub 2024 Nov 7.

Burden of liver steatosis and liver fibrosis in a large cohort of people living with HIV

Montserrat Laguno  1   2   3 , Elisa de Lazzari  1   2   3 , Leire Berrocal  1   2 , Alexy Inciarte  1   2   3 , Maria Martínez-Rebollar  1 , Lorena de la Mora  1 , Berta Torres  1   2   3 , Ana Gonzalez-Cordón  1 , Ivan Chivite  1 , Alberto Foncillas  1 , Júlia Calvo  1 , Abiu Sempere  1 , Juan Ambrosioni  1   2   3 , Jose Luís Blanco  1   2   3 , J M Miro  1   2   3 , Josep Mallolas  1   2   3 , Esteban Martínez  1   2   3
Affiliations

Burden of liver steatosis and liver fibrosis in a large cohort of people living with HIV

Montserrat Laguno et al. HIV Med. 2024 Dec.

Abstract

Background: Liver steatosis (LS) and liver fibrosis (LF) can increase the risk of cardiovascular disease in people with HIV, but their prevalence and associated factors are poorly understood. This study aimed to assess the prevalence of and factors associated with LS and LF in a large cohort of people with HIV.

Methods: We conducted a cross-sectional study of consecutive people with HIV attending the Clinic of Barcelona from September 2022 to September 2023, excluding those with chronic B or/and C hepatitis virus coinfection. LS was assessed using the Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI), and LF was assessed using the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), Fibrosis-4 score (FIB-4), and the European AIDS Clinical Society (EACS) algorithm in both the whole cohort (cohort 1) and in a specific cohort more susceptible to liver disease (cohort 2). We identified independent variables associated with LS and LF using logistic regression.

Results: Cohort 1 included 4664 people with HIV; 76% and 37% of them had available HSI and FLI data, LS was present in 28% and 19%, respectively. LF risk was present in 1%, 2%, and 1% of people with HIV according to NFS, FIB-4, and EACS algorithm scores, respectively. Cohort 2 included 1345 people with HIV; 60% and 30% of them had available HSI and FLI data, LS affected 55% and 43% and LF 2%, 5%, or 3%, respectively. Factors associated with LS included current CD4 cell count, diabetes, and hypertension, whereas LF was associated with previous exposure to dideoxynucleoside drugs and current CD4 to LF. Current integrase strand transfer inhibitor (INSTI) therapy appeared protective for LF in cohort 1.

Conclusions: In this study, one in four people with HIV had LS, and the prevalence rose to one in two in those with cardiovascular risk factors. The prevalence of LF was low, but it should be considered in older people with HIV with low CD4 counts or high aspartate transaminase levels. A possible protective effect from INSTIs deserves further investigation.

Keywords: CVD risk factors; MASLD; PWH; liver fibrosis; liver steatosis.

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Conflict of interest statement

No conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of people with HIV participating in the study. (a) Cohort 1 included people with HIV who had at least one analysis during the study period, September 2022 to September 2023. (b) Cohort 2 includes people with HIV in cohort 1 *with data about liver viruses and **who met any of the criteria defined for the risk cohort. Ac VHC+; Ag VHBs+; ALT, alanine transaminase; AST, aspartate transaminase; d‐drugs, dideoxynucleoside drugs; FIB‐4, Fibrosis‐4 index; FLI, Fatty Liver Index; HBVs Ag+, positive hepatitis B virus surface antigen; HCV Ab+, ositive hepatitis C virus serology; HSI, Hepatic Steatosis Index; NAFLD, non‐alcoholic fatty liver disease.
FIGURE 2
FIGURE 2
Multivariable logistic regression model: (a) factors related to steatosis in cohorts 1 and 2. (b) Factors related to fibrosis in cohorts 1 and 2. d‐drugs, dideoxynucleoside drugs; DM, diabetes mellitus; HTN, hypertension; INSTI, integrase strand transfer inhibitor; OR, odds ratio; VL, viral load. Data are presented as odds ratio (95% confidence interval).
See this image and copyright information in PMC

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