Increased BMI and Type 2 diabetes are the main predictors of NAFLD and advanced fibrosis in liver biopsies of patients with HIV mono-infection.
File(s)
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Liver disease is an important cause of morbidity and mortality in people living with HIV (PLWH), of which non-alcoholic fatty liver disease (NAFLD) is an increasingly recognised cause. There is limited data investigating NAFLD in HIV mono-infection and histologically defined disease. We aimed to identify who is at risk of fibrosis, NAFLD and NASH among PLWH, and explore the diagnostic accuracy of non-invasive markers of fibrosis. METHODS: Retrospective cross-sectional international multicentre study including patients with HIV mono-infection, without chronic viral hepatitis or other known causes of chronic liver disease, who underwent liver biopsy for abnormal liver biochemistry and/or clinical suspicion of liver fibrosis. RESULTS: One hundred and sixteen patients from 5 centres were included. Sixty-three (54%) had NAFLD, of whom 57 (92%) had NASH. Overall, 36 (31%) had advanced fibrosis (≥F3) and 3 (3%) cirrhosis. Of the 53 cases without NAFLD, 15 (28%) had advanced fibrosis. Collagen proportionate area (CPA) was similar between cases with and without NAFLD (3% vs 2%). Body mass index (BMI) was independently associated with NAFLD (aOR 1.2 95% CI 1.08-1.34), and type 2 diabetes was independently associated with advanced fibrosis (aOR 3.42 95% CI 1.00-11.71)). The area under the curve for advanced fibrosis was 0.65 and 0.66 for both NAFLD Fibrosis Score (NFS) and FIB-4. Cut-off values of -1.455 (NFS) and 1.3 (FIB-4) have negative predictive values of 0.80 and 0.82, respectively. CONCLUSION: Advanced fibrosis is strongly associated with type 2 diabetes in PLWH. Serological markers require further optimisation.
Date Issued
2021-09-02
Date Acceptance
2020-08-30
Citation
Clinical Infectious Diseases, 2021, 73 (7), pp.e2184-e2193
ISSN
1058-4838
Publisher
Oxford University Press (OUP)
Start Page
e2184
End Page
e2193
Journal / Book Title
Clinical Infectious Diseases
Volume
73
Issue
7
Copyright Statement
© Crown copyright 2020.
This article contains public sector information licensed under the Open Government Licence v3.0 (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).
This article contains public sector information licensed under the Open Government Licence v3.0 (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32877569
PII: 5900681
Subjects
HIV
NAFLD
NASH
fibrosis
histopathology
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2020-09-02