HIV was found to be independently associated with lower odds of moderate to severe hepatic steatosis, and people infected with HIV (PWH) were found to have a lower prevalence of moderate to severe hepatic steatosis when compared with individuals without HIV, according to the results of a study recently published in The Journal of Infectious Diseases.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in adults in the Western World, with an estimated overall prevalence of 25%. NAFLD includes a wide spectrum of liver disease including hepatic steatosis, nonalcoholic steatohepatitis (NASH), liver cirrhosis, liver failure, and hepatocellular carcinoma. Although hepatic steatosis has been considered a benign condition, a recent study of individuals without HIV who underwent serial liver biopsies showed that 44% of individuals with baseline hepatic steatosis progressed to NASH and 22% of individuals progressed to advanced fibrosis. Therefore, risk factors for NAFLD need to be identified to prevent disease progression. Furthermore, there has been reported to be a high prevalence of NAFLD in PWH, ranging from 13% to 73% due to substantial differences in diagnostic methods used and study populations. However, risk factors for NAFLD in HIV infection have differed in previous study reports. This study was conducted to compare the prevalence of and determine risk factors for moderate to severe hepatic steatosis in the setting of HIV infection.
A total of 453 individuals were included in the Copenhagen Co-Morbidity in HIV infection Study (COCOMO; ClinicalTrials.gov Identifier: NCT02382822) and 765 participants were included in the Copenhagen General Population Study. None of the participants had prior or current viral hepatitis or reported excessive alcohol intake. Unenhanced computed tomography of the liver was used to assess the presence of moderate to severe hepatic steatosis, which was defined as liver attenuation £48 Hounsfield units. Adjusted logistic regression was used to compute adjusted odds ratios (aOR).
The prevalence of moderate to severe hepatic steatosis was found to be lower in PWH vs uninfected control participants (8.6% vs 14.2%; P <.001). Factors that were associated with being protective against moderate to severe hepatic steatosis included HIV infection (aOR 0.44: P <.01), female sex (aOR 0.08; P =.03), physical activity level (aOR 0.09 for very active vs inactive; P <.01), and alcohol intake (aOR 0.89 per unit/wk; P =.02). Factors that were associated with higher odds of hepatic steatosis included male sex, increased BMI (aOR 1.58 per 1 kg/m2; P <.01), increased alanine aminotransferase level (aOR 1.76 per 10 U/L; P <.01), and exposure to integrase inhibitors (aOR 1.28 per year; P =.02).
The study design did not permit any distinction as to whether the difference in the proportion of hepatic steatoses between the 2 groups was related to HIV or just factors associated with HIV, which represents a limitation of the study.
Overall, the study authors conclude that, “the prevalence of moderate-to-severe hepatic steatosis in this cohort of well-treated PWH was lower compared to a demographically comparable cohort of HIV uninfected individuals, and HIV infection was independently associated with lower odds of moderate-to-severe hepatic steatosis.”
Kirkegaard-Klitbo DM, Fuchs A, Stender S, et al. Prevalence and risk factors of moderate to severe hepatic steatosis in HIV infection: The Copenhagen Co-Morbidity Liver Study [published online May 16, 2020]. Infect Dis. doi:10.1093/infdis/jiaa246/5838262