Expert Panel Review on Nonalcoholic Fatty Liver Disease in Persons With Human Immunodeficiency Virus

Lake, Jordan E.; Overton, Turner; Naggie, Susanna; Sulkowski, Mark S.; Loomba, Rohit; Kleiner, David E.; Price, Jennifer; Chew, Kara W.; Chung, Raymond T.; Corey, Kathleen E.

doi:10.1016/j.cgh.2020.10.018

Cited by 44 publications

(63 citation statements)

References 82 publications

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“…The overall prevalence of hepatic steatosis in patients with HIV in our cohort was 65.4%, a nding that was higher than other studies using imaging and invasive studies as diagnostic tools [4,7]. There are several factors that could potentially account for the higher prevalence rate of hepatic steatosis in our study.…”

Section: Discussionmentioning

confidence: 48%

“…Cross-sectional studies in HIV positive patients have looked at the prevalence of steatosis determined by non-invasive methods, including ultrasound, CT scan, and elastography, with prevalence ranging from 13 to 55% [2][3][4]. Studies including HCV co-infected patients have similar prevalence rates [5,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Data on the prevalence and consequences of non-alcoholic fatty liver disease (NAFLD) in people living with HIV and on the risk factors for progression to brosis are limited. The reported prevalence of steatosis in HIV infection varies from 20-63% [2][3][4]. There is controversy over the prevalence compared to the general population, and only a few studies have compared HIV-infected and uninfected adults [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the Association of HIV Infection with Hepatic Steatosis or Fibrosis: a Cross-sectional Case–Control Study

Debroy

Nagraj

Chamorro-Pareja

et al. 2021

SN Compr. Clin. Med.

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Background: Human immunode ciency virus (HIV) infection and antiretroviral therapy have been associated with non-alcoholic fatty liver disease (NAFLD), but few studies have evaluated whether HIV infection is an independent risk factor for the development of hepatic steatosis and advanced liver brosis.Objectives: To study the prevalence and severity of hepatic steatosis and advanced brosis in people living with HIV and control outpatients.Methods: We conducted a cross-sectional analysis of relevant data from 875 pairs of individuals belonging to an HIV-dedicated outpatient clinic and an adult primary care clinic of an inner-city hospital.Hepatic Steatosis Index (HSI) and FIB-4 index were calculated as non-invasive measures of steatosis and brosis, respectively. A multivariate logistic regression analysis was performed to assess predictors of steatosis and advanced brosis.Results: The prevalence of hepatic steatosis, determined by HSI ≥36, was higher in HIV-negative subjects (71.5% vs. 65.4%, p=0.006). The prevalence of advanced brosis, determined by FIB-4 index ≥3.25, was higher in the HIV-positive group (7% vs. 1.7%, p <0.001). Multivariable analysis did not identify HIV infection to be an independent risk factor for hepatic steatosis (p=0.068) and advanced brosis.Conclusions: In this cohort, hepatic steatosis was more prevalent in non-HIV infected patients, while advanced brosis had a higher prevalence in people living with HIV. HIV infection was not found to be an independent risk factor for either hepatic steatosis or brosis.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of the Association of HIV Infection with Hepatic Steatosis or Fibrosis: a Cross-sectional Case–Control Study

Debroy

Nagraj

Chamorro-Pareja

et al. 2021

SN Compr. Clin. Med.

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“…Metabolic-associated fatty liver disease (MAFLD) is a disease spectrum ranging from steatosis to nonalcoholic steatohepatitis and end-stage liver disease [4]. While MAFLD affects approximately 25% of the general population, 20% -63% of PLHIV have MAFLD and 14% -63% have non-alcoholic steatohepatitis with fibrosis [5][6][7][8]. Additionally, MAFLD is an independent risk factor for cardiovascular disease, diabetes mellitus, and all-cause mortality [7].…”

Section: Introductionmentioning

confidence: 99%

“…While MAFLD affects approximately 25% of the general population, 20% -63% of PLHIV have MAFLD and 14% -63% have non-alcoholic steatohepatitis with fibrosis [5][6][7][8]. Additionally, MAFLD is an independent risk factor for cardiovascular disease, diabetes mellitus, and all-cause mortality [7].…”

Section: Introductionmentioning

confidence: 99%

Pioglitazone for the Treatment of Metabolic-Associated Fatty Liver Disease in People Living With HIV and Prediabetes

Kamolvisit

Chirnaksorn

Nimitphong

et al. 2021

Cureus

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BackgroundMetabolic-associated fatty liver disease (MAFLD) is increasingly common among people living with the human immunodeficiency virus (PLHIV) and can progress to cirrhosis and cirrhotic-related complications. Pioglitazone is known to improve insulin sensitivity that results in decreasing serum fatty acids and resolution of non-alcoholic steatohepatitis. This study was aimed to evaluate the efficacy of pioglitazone for the treatment of MAFLD in PLHIV and prediabetes. MethodsA randomized controlled trial was conducted in HIV-positive individuals with prediabetes who had evidence of a fatty liver by abdominal ultrasonography or controlled attenuation parameter (CAP) ≥ 238 decibels per meter (dB/m) through using transient elastography. Participants were randomized to take pioglitazone, 30 mg/day, (pioglitazone group) or placebo (control group) and were followed up and assessed for 48 weeks. ResultsA total of 98 participants were enrolled, 49 in each group. The mean age was 50.8 years and 66.3% were males. All participants had received antiretroviral therapy with undetectable HIV ribonucleic acid (RNA) and the mean CD4 cell count was 463.2 cells/mm 3 . The mean baseline CAP and liver stiffness were 285.7 dB/m and 5.4 kilopascals (kPa), respectively. At 24 weeks, the mean change of the CAP level was -25.7 dB/m in the pioglitazone group and -5.6 dB/m in the control group (p = 0.040); the mean change of liver stiffness was 0.014 kPa in the pioglitazone group and 0.403 kPa in the control group (p = 0.199). At 48 weeks, the mean change of the CAP level was -23.5 dB/m in the pioglitazone group and 10.2 dB/m in the control group (p < 0.001); the mean change of liver stiffness was -0.184 kPa in the pioglitazone group and 0.554 kPa in the control group (p = 0.016). The mean changes of fasting plasma glucose (FPG) at 24 and 48 weeks were -14.9 and -17.5 mg/dL in the pioglitazone group, respectively, and -3.6 and 4.5 mg/dL in the control group, respectively (p < 0.05). The mean change of the body mass index, lipid profiles, and liver enzymes were not different between the two groups at both time points (p > 0.05). No serious adverse effects were observed in either group. ConclusionsPioglitazone significantly reduces CAP, liver stiffness, and FPG in PLHIV with prediabetes and MAFLD. Further studies with long-term follow-up duration are warranted to determine the role of pioglitazone for clinical use in this population.

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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

et al. 2023

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Introduction Non‐alcoholic fatty liver disease (NAFLD) has become a significant concern among people living with HIV (PLHIV), albeit its burden remains unclear. The primary objective of this systematic review (SR) and meta‐analysis (MA) was to estimate the prevalence of NAFLD and significant fibrosis in PLHIV. The secondary objective was to determine the risk factors for NAFLD among PLHIV. Methods We searched MEDLINE and Scopus from inception to 30 December 2022 for peer‐reviewed studies that included PLHIV and reported the prevalence of NAFLD. MA of proportions was used to estimate the pooled prevalence of NAFLD and significant fibrosis. MA of pre‐calculated effect estimates examined risk factors for NAFLD in PLHIV. Results We included 24 articles published between 2009 and 2022, encompassing 6326 PLHIV. The pooled prevalence of NAFLD was 38% (95% CI: 31–45%) with high heterogeneity (I2 = 96.3%). The pooled prevalence of significant fibrosis was 13% (95% CI: 8–18%) with high heterogeneity (I2 = 92.09%). Subgroup analyses showed a NAFLD prevalence of 40% (95% CI: 24–57%) in the United States, 33% (95% CI: 31–36) in Asia, 42% (95% CI: 24–61%) in Europe and 33% (95% CI: 29–37) in South America. When stratifying by income level, NAFLD was 39% (95% CI: 31–48) prevalent in PLHIV from high‐income economies and 34% in both upper‐middle‐income (95% CI: 31–37%) and lower‐middle‐income economies (95% CI: 28–41%). Higher body mass index (BMI) (OR = 1.32, 95% CI: 1.13–1.55; I2 = 89.9%), increasing triglycerides (OR = 1.48, 95% CI: 1.22–2.79; I2 = 27.2%) and dyslipidaemia (OR = 1.89, 95% CI: 1.32–2.71; I2 = 15.5%) were all associated with higher risk‐adjusted odds of NAFLD in PLHIV. Discussion The burden of NAFLD and significant fibrosis in PLHIV is significant. Therefore, targeted efforts to screen and diagnose NAFLD in this population are needed. Health services for PLHIV could include ways to target NAFLD risk factors, screen for liver disease and implement interventions to treat those with significant fibrosis or more advanced stages of liver disease. Taking no action to address NAFLD in PLHIV should not be an option. Conclusions This SR and MA found a 38% NAFLD and 13% significant fibrosis prevalence in PLHIV. Increasing triglyceride levels, higher BMI values and dyslipidaemia were associated with higher risk‐adjusted odds of NAFLD among PLHIV.

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Expert Panel Review on Nonalcoholic Fatty Liver Disease in Persons With Human Immunodeficiency Virus

Cited by 44 publications

References 82 publications

Assessment of the Association of HIV Infection with Hepatic Steatosis or Fibrosis: a Cross-sectional Case–Control Study

Assessment of the Association of HIV Infection with Hepatic Steatosis or Fibrosis: a Cross-sectional Case–Control Study

Pioglitazone for the Treatment of Metabolic-Associated Fatty Liver Disease in People Living With HIV and Prediabetes

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

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