One-third of young adults living with HIV since birth or early childhood have nonalcoholic hepatic steatosis, a prevalence that is comparable with that in older adults with HIV and significantly greater than in individuals without HIV, according to study results published in The Journal of Infectious Diseases.
In this prospective cross-sectional study, researchers used transient elastography to evaluate liver fibrosis and steatosis in 46 young adults with lifelong HIV and a control group of 20 individuals who did not have HIV, matched by age, race, and gender.
In the HIV group, 70% of the participants were virally suppressed (HIV RNA <40 copies/mL). Mean age was 28 years and 61% were women. Mean CD4 T-cell count was 605 cells/µL and patients had an average of 19 years of antiretroviral therapy exposure.
Categoric cutoffs for ≥grade 1 (controlled attenuation parameter [CAP] ≥248 dB/m) and ≥grade 2 (CAP ≥268 dB/m) steatosis showed a higher prevalence of hepatic steatosis in the HIV group compared with the control group: 33% vs 10% for ≥grade 1 steatosis (P =.04); 28% vs 5% for ≥grade 2 steatosis (P =.02).
Transient elastography and aspartate transaminase (AST)-to-platelet ratio index evaluations showed no significant differences between the 2 groups with respect to fibrosis estimates.
Hepatic steatosis in the HIV group was positively associated with body mass index (r=0.4; P =.0008), waist circumference (r=0.54; P =.0001), cholesterol (r=0.25; P =.04), and homeostatic model to assess insulin resistance (r= 0.35; P =.005). In the multivariate analysis, waist circumference emerged as the only independent risk factor for hepatic steatosis in this group (P =.03).
“Future studies with larger sample sizes and longitudinal follow-up are needed to further elucidate the role of HIV and HIV-related risk factors in [non-alcoholic fatty liver disease] and to assess the predictive abilities of transient elastography for future progression of liver disease in [people living with HIV since birth or early childhood],” concluded the researchers.
Aepfelbacher JA, Balmaceda J, Purdy J, et al. Increased prevalence of hepatic steatosis in young adults with life-long HIV [published online March 10, 2019]. J Infect Dis. doi:10.1093/infdis/jiz096