People living with HIV and non-alcoholic fatty liver disease (NAFLD) and antiretroviral-associated lipodystrophy may be at increased risk of developing type 2 diabetes (T2DM), according to study results published in Clinical Infectious Diseases.

In people with HIV, a common cause of liver disease in NAFLD. Previous studies have suggested that NAFLD prevalence may be more common in people with HIV compared with the general population; however, data are inconsistent. Further, an increased risk for lipodystrophy is seen in people with HIV who have been exposed to combination antiretroviral therapy, specifically stavudine and zidovudine.

Antiretroviral-drug induced lipodystrophy is characterized by lipoatrophy, which includes insulin resistance features like increased liver fat (LFAT) and a disturbed glucose metabolism. Individuals with lipodystrophy who have HIV may be at increased risk for T2DM, but no longitudinal studies have been performed. Therefore, this longitudinal study determined the natural course of NAFLD and T2DM in people with HIV with and without lipodystrophy over a period of 16 years.

In total, 14 people with HIV were included in the study, as well as. In addition, 28 healthy participants Both LFAT (by proton magnetic resonance spectroscopy) and clinical characteristics were measured at baseline and after 16 years. Using transient elastography and magnetic resonance elastography, liver stiffness was measured to estimate liver fibrosis.

During the 16-year follow-up, results suggested that the development of T2DM was more common than the progression of NAFLD in people with HIV. At the follow-up visit, compared with the control group, the HIV-positive group gained more body fat (P <.001), had increased features of insulin resistance (fasting glucose, insulin, and homeostasis model assessment of insulin resistance), and were more likely to develop T2DM (P <.01). Further, compared with people without lipodystrophy, LFAT was higher at baseline in people with lipodystrophy (P <.001); however, LFAT remained stable in all groups during follow-up. In addition, liver stiffness with transient elastography was similar in all groups at follow-up and liver stiffness with magnetic resonance elastography was similar in the participants with and without lipodystrophy, but advanced fibrosis by magnetic resonance elastography was observed in 3 participants with lipodystrophy and none of the participants without lipodystrophy.

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Overall, the study authors concluded that, “Although NAFLD is prevalent in both [people with HIV] and control[s] and progress to fibrosis, the present measurements of liver stiffness at the time of follow-up suggest that advanced fibrosis is a very rare complication compared to type 2 diabetes in [people with HIV].”

Reference

Lallukka-Brück S, Isokuortti E, Luukkonen PK, et al. Natural course of NAFLD and type 2 diabetes in HIV-positive subjects with and without combination antiretroviral therapy (cART)-associated lipodystrophy: a 16-year follow-up study [published online May 25, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz435/5498863