Background: Liver disease remains one of the main causes of non-AIDS mortality in HIV-infected individuals. Transient elastography (TE) is an accurate imaging method to estimate liver fibrosis and steatosis. We aimed to evaluate the risk factors associated with liver fibrosis and steatosis in HIV mono-infected patients under long-term combined-antiretroviral therapy (c-ART).
Methods: This cross-sectional study prospectively included HIV-infected adult patients under c-ART (PROSPEC-HIV; NCT02542020). Liver stiffness measurement (LSM) and Controlled Attenuation Parameter (CAP) by TE were used to estimate liver fibrosis and steatosis, respectively. Exclusion criteria were hepatitis coinfection and c-ART naïve. Patients with an unreliable M probe LSM or CAP were excluded from the liver fibrosis and steatosis analyses, respectively. Clinical evaluation, fasting blood tests and TE were performed at the same day. TE exams were performed by a single experimented operator blinded to clinical and laboratory data. Metabolic factors were defined according to the International Diabetes Federation criteria. Alcohol consumption was quantified using the AUDIT score. Presence of liver fibrosis and steatosis were considered when LSM ≥ 8.0kPa and CAP ≥ 250dB/m, respectively. Age and gender-adjusted multivariate logistic regression was performed.
Results: A total of 348 HIV mono-infected patients [61% female, median (IQR) age=44 (34-52) years, BMI=25.4 (23.0-29.3) kg/m²] were included. Median (IQR) time under c-ART and under the current c-ART regimen were 7.3 (4.1-12.8) and 4.3 (1.9-7.5) years, respectively. LSM and CAP were unreliable in 6% and 12%. Liver fibrosis and steatosis prevalence were 9% (n=30/326) and 33% (n=102/305). In age and gender adjusted multivariate analysis, factors associated [OR (95%CI)] with liver fibrosis were: age > 45 years [2.91 (1.19-7.15); p=0.020]; CD4 count < 200 cells [5.00 (1.38-18.21); p=0.014] and type-2 diabetes [3.04 (0.97-9.55); p=0.056]. Male gender [5.69 (2.68-12.04); p< 0.001]; dyslipidemia [2.86 (1.46-5.60); p=0.002]; type 2 diabetes [6.00 (2.08-17.28); p=0.001] and central obesity [10.24 (4.11-25.50); p< 0.001] were independently associated with liver steatosis.
Conclusions: Non-communicable diseases (NCD) can play a major role in the development of liver fibrosis and steatosis. NCD prevention and care services need to be integrated to HIV care to decrease the burden of hepatic events in HIV-infected individuals.