Results show that hepatic steatosis was increased in people with HIV, and positively associated with BMI, waist circumference, cholesterol, and homeostatic model to assess insulin resistance. One-third of young adults living with HIV since birth or early childhood have nonalcoholic hepatic steatosis, a prevalence that is comparable with that in older adults with HIV and significantly greater than in individuals without HIV, according to study results published in The Journal of Infectious Diseases .
In this prospective cross-sectional study, researchers used transient elastography to evaluate liver fibrosis and steatosis in 46 young adults with lifelong HIV and a control group of 20 individuals who did not have HIV, matched by age, race, and gender.
In the HIV group, 70% of the participants were virally suppressed (HIV RNA <40 copies/mL). Mean age was 28 years and 61% were women. Mean CD4 T-cell count was 605 cells/µL and patients had an average of 19 years of antiretroviral therapy exposure.
Categoric cutoffs for ≥grade 1 (controlled attenuation parameter [CAP] ≥248 dB/m) and ≥grade 2 (CAP ≥268 dB/m) steatosis showed a higher prevalence of hepatic steatosis in the HIV group compared with the control group: 33% vs 10% for ≥grade 1 steatosis ( P =.04); 28% vs 5% for ≥grade 2 steatosis ( P =.02).
Transient elastography and aspartate transaminase (AST)-to-platelet ratio index evaluations showed no significant differences between the 2 groups with respect to fibrosis estimates.
Hepatic steatosis in the HIV group was positively associated with body mass index (r=0.4; P =.0008), waist circumference (r=0.54; P =.0001), cholesterol (r=0.25; P =.04), and homeostatic model to assess insulin resistance (r= 0.35; P =.005). In the multivariate analysis, waist circumference emerged as the only independent risk factor for hepatic steatosis in this group ( P =.03).
“Future studies with larger sample sizes and longitudinal follow-up are needed to further elucidate the role of HIV and HIV-related risk factors in [non-alcoholic fatty liver disease] and to assess the predictive abilities of transient elastography for future progression of liver disease in [people living with HIV since birth or early childhood],” concluded the researchers.
Aepfelbacher JA, Balmaceda J, Purdy J, et al. Increased prevalence of hepatic steatosis in young adults with life-long HIV [published online March 10, 2019]. J Infect Dis . doi:10.1093/infdis/jiz096
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