NAFLD Linked With Traditional Metabolic Risk Factors in People Living with HIV

Nonalcoholic fatty liver disease (NAFLD) is common among people living with HIV, but the associated risk factors have been widely unknown.

According to new research presented the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 9-13, 2018, in San Francisco, California, investigators found that in people living with HIV, traditional metabolic risk factors, including low HDL cholesterol, hypertriglyceridemia, and body mass index (BMI) were associated with NAFLD.

A team of investigators from Massachusetts General Hospital, the University of Colorado Denver, and the University of Texas Health Science Center, set out to identify metabolic and HIV-specific risk factors for NAFLD in people living with HIV, by searching the Partners HealthCare Research Patient Data Registry to identify people living with HIV both with and without NAFLD.

From the database, 97 individuals with HIV and NAFLD and 135 without were identified, excluding individuals with significant alcohol use or viral hepatitis. The investigators defined the presence of NAFLD as fatty infiltration of the liver on imaging using either previously validated criteria or steatosis on biopsy. Absence of NAFLD was defined as normal liver imaging and/or histology.

The investigators used Student's t test or Mann-Whitney U test to analyze continuous variables and Pearson χ2 test or Fishers exact test to compare proportions.

The results indicate that the presence of NAFLD was corroborated by higher Fibrosis-4 scores (M = 1.83, SD 1.31) than in those without NAFLD (M = 1.47, SD=0.78), (P = .01).

During univariate analysis, people living with HIV who also had NAFLD were more likely to have obstructive sleep apnea, hypertension, diabetes mellitus, low HDL, high triglycerides, and cardiovascular disease compared to individuals without NAFLD (P<.01 for all).

When using multivariable logistic regression modeling was used to determine risk factors for NAFLD, the investigator found several traditional cardiometabolic risk factors including lower HDL (odd ratio [OR] 0.975, 95% CI 0.95-0.999, P = .039) and higher triglyceride levels (OR 1.004,95% CI 1.001-1.008, P = .015), as well as higher BMI (OR 1.077, 95% CI 1.013-1.146, P = .019).

The investigators also observed a trend toward an association between current or prior use of abacavir and NAFLD (OR 1.895, 95% CI 0.891-4.032, P = .097). Additionally, it was observed that individuals with CD4 counts less than 200 cells/mm³ had an increased risk of NAFLD (OR 3.749, 95% CI 1.337-10.511, P = .012).

Among those with NAFLD, CD4 counts < 200 cells/mm³ were associated with advanced fibrosis as assessed by Fibrosis-4 score (P = .02), which is potentially the result of persistent systematic inflammation seen with immune suppression

The investigators noted that there were no differences observed by group in age, gender, race, or tobacco use. Additionally, the duration of HIV and use of protease inhibitors, integrase inhibitors, NRTIs, or NNRTIs was not associated with NAFLD.

The investigators indicated that larger prospective studies are needed to better understand additional HIV-specific risk factors.

The presentation “Factors Associated with Nonalcoholic Fatty Liver Disease in HIV,” was presented in a poster presentation on November 12, 2018 at the American Association for the Study of Liver Diseases Liver Meeting in San Francisco, California.