Assessment of Noninvasive Markers of Steatosis and Liver Fibrosis in Human Immunodeficiency Virus-Monoinfected Patients on Stable Antiretroviral Regimens

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is a major non–AIDS-defining condition for persons living with HIV (PLWHIV). We aimed to validate noninvasive tests for the diagnosis of NAFLD in PLWHIV. Methods Cross-sectional study of PLWHIV on stable ART with persistently elevated transaminases and no known liver disease. The AUROC was calculated to compare the diagnostic accuracy of liver biopsy with abdominal ultrasound, transient elastography (including CAP), and noninvasive markers of steatosis (TyG, HSI, FLI) and fibrosis (FIB-4, APRI, NAFLD fibrosis score). We developed a diagnostic algorithm with serial combinations of markers. Results Of 146 patients with increased transaminase levels, 69 underwent liver biopsy (90% steatosis, 61% steatohepatitis, and 4% F≥3). The AUROC for steatosis was: ultrasound, 0.90 (0.75–1); CAP, 0.94 (0.88–1); FLI, 0.81 (0.58–1); HSI, 0.74 (0.62–0.87); and TyG, 0.75 (0.49– 1). For liver fibrosis ≥ F3, the AUROC for TE, APRI, FIB-4, and NAFLD fibrosis score was 0.92 (0.82–1), 0.96 (0.90–1), 0.97 (0.93–1), and 0.85 (0.68–1). Optimal diagnostic performance for liver steatosis was for 2 noninvasive combined models of tests with TyG and FLI/HSI as the first tests and ultrasound or CAP as the second tests: AUROC, 0.99 (0.97–1, P < 0.001) and 0.92 (0.77–1, P < 0.001). Conclusions Ultrasound and CAP performed best in diagnosing liver steatosis, and FLI, TyG, and HSI performed well. We propose an easy-to-implement algorithm with TyG or FLI as the first test and ultrasound or CAP as the second test to accurately diagnose or exclude NAFLD.

Uncovering the NAFLD burden in people living with HIV from high‐ and middle‐income nations: a meta‐analysis with a data gap from Subsaharan Africa

“…[18] and included two additional references that fulfilled the review's inclusion/exclusion criteria. Twenty‐four articles ( n = 24) were finally included [40–63]. Table S2 in the Supplementary File lists a number of key articles that were excluded from the present SR (reasons for exclusion are provided in the Table).…”

“…The pooled prevalence from the two studies with a CAP threshold for NAFLD diagnosis of ≥238 dB/m was 34% (95% CI: 29-38%) (heterogeneity not estimable). One study used a CAP threshold of ≥251 dB/m, finding a NAFLD prevalence of 34% (95% CI: [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Another one that defined NAFLD as a CAP≥275 dB/m found a 34% (95% CI: 25-44) NAFLD prevalence (heterogeneity not estimable).…”

Regional variation in NAFLD prevalence and risk factors among people living with HIV in Europe: a meta-analysis

“…After reviewing the full texts, a total of 36 studies met the inclusion criteria and were included in the final analysis ( 11 , 30–64 ) ( Figure 1 ). These studies were all from European countries, including the United Kingdom ( 42 , 46 ), France ( 31 , 35 , 38–40 , 64 ), Belgium ( 39 , 40 ), Greece ( 30 , 41 ), Italy ( 11 , 34 , 44 , 48 , 53 , 62 ), Spain ( 33 , 45 , 50 , 51 , 55 , 56 ), Denmark ( 36 ), Finland ( 37 , 57 ), Germany ( 32 , 39 , 40 , 43 , 49 , 58 , 63 ), Switzerland ( 54 ), Serbia ( 47 , 61 ), Austria ( 59 ), and Turkey ( 52 , 60 ) ( Supplementary Table S1 ). Most of the studies were cross-sectional in design, with a few prospective cohort studies.…”

“…Only one study focused on adolescents ( 64 ), while the rest were conducted on adults. Based on the geographical distribution of the study population across different European countries, they were categorized into Central Europe (CE) ( 32 , 43 , 49 , 54 , 58 , 59 , 63 ), Western Europe (WE) ( 31 , 35 , 38 , 42 , 46 , 64 ), Eastern Europe (EE) ( 47 , 52 , 60 , 61 ), Southern Europe (SE) ( 11 , 30 , 33 , 34 , 41 , 44 , 45 , 48 , 50 , 51 , 53 , 55 , 56 , 62 ), and Northern Europe (NE) ( 36 , 37 , 57 ). Two multicenter studies ( 39 , 40 ) included patients from Belgium, France, and Germany.…”

Risk Stratification of Advanced Fibrosis in Patients With Human Immunodeficiency Virus and Hepatic Steatosis Using the Fibrosis-4, Nonalcoholic Fatty Liver Disease Fibrosis, and BARD Scores

“…Noninvasive imaging methods such as transient elastography (TE) have been validated in PWH and provide accurate and reliable measurements of liver fibrosis [ 16–18 ]; however, they are costly and not always available in primary care clinics. Consequently, several predictive noninvasive scores have been developed such as the Fibrosis-4 (FIB-4) [ 19 ], NAFLD fibrosis (NFS) [ 20 ], and body mass index, aspartate transaminase/alanine transaminase ratio, and diabetes score (BARD) scores [ 21 ]. These scores use routine laboratory tests and anthropometric measures and have demonstrated acceptable diagnostic performance, especially for risk stratification of advanced fibrosis in NAFLD, which has led to their increased use as diagnostic tools in both the general population and PWH [ 19–22 ].…”