Hepatic Steatosis in People With HIV, People who Use Intravenous Drugs

Patients with HIV and those with a history of intravenous drug use may have significantly higher rates of hepatic steatosis, according to research results presented at the virtual Conference on Retroviruses and Opportunistic Infections, held from March 8 to 11, 2020.

Two groups of researchers examined the role of hepatic steatosis across these patient populations. The first study¹, conducted by Benfield and colleagues, examined the association between antiretroviral therapy (ART) and moderate to severe hepatic steatosis in a cohort of patients with HIV, but no history of hepatitis B or C, or of alcohol abuse. The second study,² Benson et al focused on people with HIV and those who inject drugs.

Benfield et al examined by data from 516 people with HIV (median age 51 years; interquartile range 43.8-60.0; 86% men). Of these, 7.2% had moderate to severe hepatic steatosis. Route of HIV transmission was also established, and indicated that 5% of this population included intravenous drug users. Investigators performed logistic regression analyses adjusting for age, sex, body mass index, and duration of HIV.

The results demonstrated that the adjusted odds ratios for cumulative exposure to stavudine associated with moderate to severe clinical hepatic steatosis were 2.99 (95% CI, 1.10-8.16) in those who were ever-exposed to ART and 1.22 (95% 1.04-1.45) for cumulative exposure measured per-year. Further, the adjusted odds ratios for cumulative exposure to elvitegravir and raltegravir were 2.67 (95% CI, 1.52-4.67) and 1.18 (95% CI, 1.07-1.37), respectively.  No link was found between moderate and severe hepatic steatosis and either any or cumulative exposure to nucleoside reverse-transcriptase inhibitors, non-nucleoside reverse-transcriptase inhibitors, or protease inhibitors.

Benson and colleague investigated data from 1174 adults (n=934 without steatosis and n=240 with steatosis) who were enrolled in the AIDS Linked to the Intravenous Experience (ALIVE) study. Results demonstrated that 30% of patients with steatosis and 24% of those without were HIV positive. Further, 44% of patients with steatosis and 25% of those without, current intravenous illicit drug users.

“Among HIV-infected ALIVE participants, those on an [integrase strand transfer inhibitor]-based ART regimen were twice as likely to have hepatic steatosis as those on [protease inhibitor]-based ART regimens,” the researchers wrote, adding that steatosis prevalence was more likely in women compared with men (25% vs 18%). The prevalence of hepatic steatosis, they added, will likely increase in these patient populations as people who inject drugs age and develop comorbid conditions.

In both studies, researchers concluded that further research is needed to assess the relationship between antiretroviral therapies, HIV diagnosis, intravenous drug use, and hepatic steatosis.

References

1. Benfield T, Lundgren J, Bendtsen F, Nielsen SD, Kirkegaard-Klitbo DM; on behalf of the COCOMO study group. Hepatic steatosis associated with exposure to elvitegravir and raltegravir. Presented at: CROI 2020; March 8-11, 2020. http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.

2. Benson E-MA, Mehta S, Astemborski J, et al; on behalf of the ALIVE study. Investigation of classic and HIV-related factors for hepatic steatosis among PWID. Presented at: CROI 2020; March 8-11, 2020; http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.