Is Liver Stiffness Seen in HIV Patients a Result of Hepatotoxic Drug Exposure?

Liver with cirrhosis, computer illustration. Cirrhosis is a consequence of chronic liver disease characterized by fibrosis and scarring of tissue.
Researchers aimed to estimate the prevalence of liver fibrosis and factors associated with it in people living with HIV compared with those in a control group.

Researchers observed a higher prevalence of liver stiffness measurement (LSM) among people living with HIV (PWH) compared with the general population. These findings from a cross-sectional cohort study were published in the The Journal of Infectious Diseases.

For this analysis, data from 2 studies were pooled. PWH (n=342) were recruited from clinics in Copenhagen between 2015 and 2016, and as controls, inhabitants (n=2190) of the Netherlands were enrolled between 2011 and 2014. LSM was defined as 5.5 (±1.6) kilopascal (kPa) as assessed by transient elastography.

Compared with those in the control group, PWH were more likely to be men, were younger, and were less likely to be White (all P <.01). They also had greater abdominal obesity, higher triglyceride and alanine aminotransferase levels (ALT), and more instances of metabolic syndrome (all P <.01). PWH also had lower body mass indexes and total cholesterol levels than members of the control group (both P <.01). PWH also consumed less alcohol (P =.03).

Elevated LSM was observed among 12% of PWH and 7% of the control group (P <.01). Mild, moderate, and severe fibrosis was higher among PWH (P <.01). Moderate to severe hepatic steatosis was 8% among PWH and 35% among the control group.

Among PWH, those with elevated LSM were older, were more likely to have diabetes or hepatic steatosis, and had larger waist circumferences (all P <.01). Those with PWH with elevated LSM also had greater body mass indexes, had higher AST levels, and were more likely to be obese or overweight, and to have metabolic syndrome (all P =.02).

Having HIV was associated with elevated LSM (adjusted odds ratio [aOR], 1.84; 95% CI, 1.17-2.88; P <.001), especially among individuals aged 57 to 63 years (aOR, 4.35; 95% CI, 1.27-14.88; P =.02) or 63 to 79 years (aOR, 8.67; 95% CI, 2.56-29.35; P <.01).

This study did not include data on liver biopsy, which limited the accuracy of liver fibrosis diagnosis and staging.

These data indicated HIV infection was associated with LSM compared with data from the general population. This trend was observed despite a significantly reduced prevalence of alcohol consumption and suggested that LSM may be triggered by an exposure to hepatotoxic drugs.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kirkegaard-Klitbo DM, Bendtsen F, Lundgren J, et al. Increased prevalence of liver fibrosis in people living with HIV without viral hepatitis compared to population controls. Published online December 15, 2020. J Infect Dis. doi:10.1093/infdis/jiaa763