HIV May Up Risk for Liver Steatosis in Mono-infected Patients

AMSTERDAM -- There was a two-fold higher risk of liver steatosis in people living with HIV compared with uninfected control individuals, a researcher said here.

HIV infection was an independent risk factor for the presence of steatosis, with a significant increase in risk among individuals with HIV (OR 2.1, 95% CI 1.95-2.95, P<0.001) compared with those without HIV, reported Hugh Perazzo, MD, of Fundação Oswaldo Cruz (FIOCRUZ), PROCC in Rio de Janeiro, Brazil.

"For the last year, several studies have been describing a high prevalence of liver steatosis in HIV-mono-infected patients, ranging from 37% to 73%, but the impact of HIV on steatosis is unclear," Perazzo said at a presentation at the International AIDS Conference.

He and his colleagues aimed to examine both the prevalence and the factors that were linked with liver steatosis in HIV-mono-infected patients versus uninfected patients "paired for confounding factors."

This case-control study derived each cohort from two separate studies. The HIV-Brazilian Longitudinal Study of Adult Health cohort was comprised of HIV mono-infected patients enrolled in INI/FIOCRUZ, and were matched with uninfected controls from the longitudinal multi-center ELSA-Brasil. Participants were paired on demographics, such as age, ethnicity, and income, as well as metabolic and inflammatory characteristics, such as cIMT (carotid intima-media thickness test), cardiovascular disease, and body mass index (BMI). A nearest neighbor propensity score matching with a caliper of 0.05 was used to match cases and controls, the authors said.

Liver steatosis was defined by a Fatty Liver Index ≥60, which was described as a "serological biomarker for the detection of steatosis."

Overall, 333 cases were matched with 333 controls. The HIV-uninfected subjects were more likely to be women, significantly older (median age of 55 versus 41), of black/Pardo (Brazilian) ethnicity, and highly educated (>8 years education). Those who were not HIV infected also had a higher BMI and waist circumference, and more likely to have hypertension, dyslipidemia, and metabolic syndrome, compared with those who had HIV. However, HIV-infected patients were more likely to have type 2 diabetes.

There was a 35% prevalence of steatosis in HIV-infected patients. HIV-infected patients with steatosis were more likely to be older, have a higher CD4 count, and a longer duration of combination antiretroviral therapy (cART). In addition, more than two-thirds of HIV-infected patients with steatosis had metabolic syndrome, while 54% had "poor clinical management," 46% had dyslipidemia, and 46% had hypertension.

A multivariate analysis found that the following cardiometabolic factors were independently linked with liver steatosis in HIV-infected patients:

• Type 2 diabetes (OR 5.79, 95% CI 2.58-13.00)
• Dyslipidemia (OR 2.57, 95% CI 1.27-5.21)
• Hypertension (OR 2.56, 95% CI 1.25-5.26)
• BMI (OR 1.91, 1.67-2.18)

The co-chair of the oral session at which the data were presented, Marina Klein, MD, of McGill University Health Center in Montreal, who was not involved with the research, told MedPage Today that one of the things that clinicians will have to face as they are able to treat some of the preventable causes of advanced liver disease will be the epidemic of fatty liver disease in the HIV-infected population, in both the mono-infected HIV population and the individuals previously co-infected with other viruses.

"It's already at epidemic proportions in a large number of countries, and it's becoming a leading cause, for example, for liver transplantation in the United States in the general population," Klein said. "There are manageable factors we can intervene on -- improving diabetes, improving cholesterol -- that might help with that, but there are a lot of unknown drivers that we really need to figure out [regarding] how to reduce fatty liver disease so it doesn't have long-term consequences."

Perazzo said that potential directions for future research include examining the cumulative use of antiretroviral therapy to "see if something can be associated with steatosis" in the HIV-infected population.

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