Elevated Fatty Liver Index Increases Mortality Risk in Patients With HIV/HCV

fatty liver disease
Fatty liver, conceptual illustration. Fatty liver is commonly associated with alcohol or metabolic syndrome (diabetes, hypertension and obesity), but can also be due to any one of many causes. Fatty liver disease is a reversible condition wherein large vacuoles of fat (pale yellow circles) accumulate in liver cells.
An elevated fatty liver index appears to be a risk factor for all-cause mortality in patients coinfected with HIV and hepatitis C virus.

An elevated fatty liver index (FLI; ≥60) appears to be a risk factor for all-cause mortality in patients coinfected with HIV and hepatitis C virus (HCV) independent of liver fibrosis and HCV cure, according to a study published in Hepatology.

Patients who are coinfected with HIV and HCV are at high risk for metabolic complications such as insulin resistance, which subsequently may result in hepatic steatosis. Previous studies have demonstrated an association between hepatic steatosis in people with HIV/HCV coinfection and higher mortality risk. However, the relationship between hepatic steatosis and overall mortality in patients with this coinfection has not been clearly established via larger studies. The FLI is a noninvasive biomarker for steatosis, and is one of the most validated screening tools. However, its capacity to predict mortality risk for patients with HIV/HCV coinfection has not been previously investigated.

Therefore, using data from the French National Agency for Research on Aids and Viral Hepatitis CO13 HEPAVIH cohort, which included 983 patients and 4432 visits, researchers tested whether elevated FLI (≥60) was associated with all-cause mortality. Results found that patients with an elevated FLI had an approximately 2-fold increase in all-cause mortality risk (P =.009) independent of the following factors: HCV cure (P =.004), advanced fibrosis (P =.05), history of hepatocellular carcinoma and/or liver transplantation (P <10−3), history of indirect clinical signs of cirrhosis (P =.015), and HIV Centers for Disease Control and Prevention clinical stage C (P <10−3).

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“In conclusion, our findings indicate that an FLI ≥ 60 is a risk factor of all-cause mortality in HIV-HCV-coinfected patients independently of liver fibrosis and HCV cure,” stated the authors. They added that, “In the present era of nearly 100% HCV cure rates thanks to direct-acting antivirals, these findings encourage the more systematic use of noninvasive steatosis biomarkers to help identify coinfected patients with higher mortality risk.”

Disclosure: This clinical trial was supported by Abbott France, Glaxo‐Smith‐Kline, Roche, Schering‐Plough, BMS, and Merck‐Serono. Please see the original reference for a full list of authors’ disclosures.


Barré T, Protopopescu C, Bani-Sadr F, et al. Elevated fatty liver index as a risk factor for all-cause mortality in human immunodeficiency virus-hepatitis C virus-coinfected patients (ANRS CO13 HEPAVIH Cohort Study) [published online August 29, 2019]. Hepatology. doi:10.1002/hep.30914