Open AccessPredictive factors associated with liver fibrosis and steatosis by transient elastography in patients with HIV mono‐infection under long‐term combined antiretroviral therapy
Author(s) -
Perazzo Hugo,
Cardoso Sandra W,
Yanavich Carolyn,
Nunes Estevão P,
Morata Michelle,
Gorni Nathalia,
Silva Paula Simplicio,
Cardoso Claudia,
Almeida Cristiane,
Luz Paula,
Veloso Valdilea G,
Grinsztejn Beatriz
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25201
Subject(s) - transient elastography , medicine , steatosis , gastroenterology , fatty liver , fibrosis , odds ratio , cirrhosis , hepatitis c , confidence interval , viral load , immunology , liver fibrosis , human immunodeficiency virus (hiv) , disease
Non‐alcoholic fatty liver disease is characterized by the presence of hepatic steatosis and can be associated with fibrosis progression, development of cirrhosis and liver‐related complications. Data on the prevalence of liver fibrosis and steatosis in HIV patients remain contradictory in resource‐limited settings. We aimed to describe the prevalence and factors associated with liver fibrosis and steatosis in patients with HIV mono‐infection under long‐term antiretroviral therapy ( ART ) in Rio de Janeiro, Brazil. Methods Clinical assessment, fasting blood collection and liver stiffness measurement ( LSM )/controlled attenuation parameter ( CAP ) by transient elastography were performed on the same day for this cross‐sectional study ( PROSPEC ‐ HIV study; NCT 02542020). Patients with viral hepatitis co‐infection, ART ‐naïve or missing data were excluded. Liver fibrosis and steatosis were defined by LSM ≥ 8.0 kPa and CAP ≥ 248 dB/m respectively. HIV history, cumulative and current ART regimens were evaluated. Multivariate logistic regression models adjusted for age and gender were performed. Results In total, 395 patients (60% female; median age of 45 (IQR, 35 to 52) years, body mass index = 25.7 (23.2 to 29.4) kg/m 2 , alanine aminotransferase = 30 (23 to 42) IU/L, duration of ART for 7 (4 to 14) years) were included. LSM and CAP were reliable in 93% (n = 367) and 87% (n = 344) respectively. The prevalence of fibrosis and steatosis were 9% (95% confidence interval (CI), 7 to 13) and 35% (95% CI, 30 to 40) respectively. The following factors were associated with fibrosis (odds ratio (OR) (95% CI)): older age (per 10 years; 1.80 (1.27 to 2.55); p = 0.001) and CD4+ count <200 cells/mm 3 (7.80 (2.09 to 29.09), p = 0.002). Type 2 diabetes had a trend towards the presence of liver fibrosis (2.67 (0.96 to 7.46), p = 0.061). Central obesity (10.74 (4.40 to 26.20), p < 0.001), type 2 diabetes (9.74 (3.15 to 30.10), p < 0.001), dyslipidaemia (2.61 (1.35 to 5.05), p = 0.003) and metabolic syndrome (4.28 (2.45 to 7.46), p < 0.001) were associated with steatosis. A dominant backbone ART regimen of zidovudine ( AZT ), d4T, ddI or ddC was associated with steatosis (1.90 (1.07 to 3.38), p = 0.028) independently of metabolic features. Conclusion Integrated strategies for preventing non‐communicable diseases in people with HIV mono‐infection are necessary to decrease the burden of liver diseases. Clinical Trial Number: NCT02542020.