Hepatic steatosis among people living with HIV in Southern Brazil: prevalence and risk factors

Pezzini, Marina Ferri; Cheinquer, Hugo; Araújo, Alexandre de; Schmidt-Cerski, Carlos T; Sprinz, Eduardo; Herz-Wolff, Fernando; Poeta, Júlia

doi:10.1038/s41598-020-65133-7

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…[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).…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Subgroup Analyses (Ma Of Prevalence)mentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Subgroup Analyses (Ma Of Prevalence)mentioning

confidence: 99%

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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“…For the assessment of liver fibrosis, a cut-off value of at least 8.2 kPa was considered a significant fibrosis (≥F2) [ 17 ]. Measurement of LSM was considered reliable if the interquartile range (IQR) was less than 30% and the success rate greater than 70% [ 24 ]. To identify patients at risk of more progressive and inflammatory fatty liver disease, that is, NASH, the FAST score with cut-off values of greater than 0.35 and at least 0.67, respectively, were applied [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Prevalence and risk factors of nonalcoholic steatohepatitis with significant fibrosis in people with HIV

Michel¹,

Labenz²,

Wahl³

et al. 2022

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Objective: Metabolic risk factors and nonalcoholic fatty liver disease (NAFLD) in people with HIV (PWH) have been increasing. Patients exhibiting the inflammatory subtype nonalcoholic steatohepatitis (NASH) are at increased risk of liver-related complications. Therefore, the aim was to investigate the prevalence of NASH with significant fibrosis in PWH using noninvasive tests (NITs). Design: In this prospectively enrolling cohort study, 282 PWH were explored for hepatic steatosis, fibrosis and steatohepatitis using vibration-controlled transient elastography (VCTE) and the Fibroscan-AST (FAST) score. Methods: On the basis of controlled attenuation parameter (CAP; dB/m) and liver stiffness measurement (LSM; kPa), patients were categorized according to the presence of steatosis (≥275 dB/m) and significant fibrosis (≥8.2 kPa). The FAST score was calculated according to established cut-offs. Results: The prevalence of hepatic steatosis in this cohort was 35.5% ( n = 100) with 75 (75%) of these patients fulfilling the criteria of NAFLD. The prevalence of significant fibrosis (≥ F2) was 6.7% ( n = 19). The FAST score identified a total of 32 (12.3%) patients with a cut-off greater than 0.35, of whom 28 (87.5%) PWH qualified as NASH. On multivariable analysis, waist circumference was a predictor of hepatic steatosis and type 2 diabetes was a predictor of significant fibrosis. Type 2 diabetes and ALT remained independent predictors of a FAST score greater than 0.35. Conclusion: NASH with significant fibrosis is highly prevalent among PWH. The FAST score may be helpful to identify patients at risk for significant liver disease.

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“…[ 28 ] Only measurements with an interquartile range–to–median ratio <30% and a success rate >70% were considered valid. [ 29 ] A total of 16 patients were excluded due to invalid measurements. NAFLD was defined according to current practice guidelines.…”

Section: Methodsmentioning

confidence: 99%

Effect of hepatic steatosis and associated metabolic comorbidities on health‐related quality of life in people living with HIV

et al. 2022

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Hepatic steatosis (HS) related to nonalcoholic fatty liver disease (NAFLD) is increasing globally. In people living with human immunodeficiency virus (PLWH) risk factors of HS are increased. The impact of HS on outcomes and in particular health‐related quality of life (HRQL) in PLWH remains unknown. The aim of this cross‐sectional cohort study (FLASH, Prevalence of Advanced Fibrosis in Patients Living With HIV) was to determine the contribution of HS on HRQL in PLWH and to identify confounders on HRQL. A total of 245 PLWH were prospectively enrolled. HS was assessed using vibration‐controlled transient elastography and defined as a controlled attenuation parameter (CAP) of ≥ 275 dB/m. The analysis was performed between CAP < 275 and ≥ 275 dB/m. The generic European Quality‐of‐Life 5‐Dimension 5‐Level questionnaire was used to determine differences in the HRQL. Univariable and multivariable linear regression models were applied to identify predictors with impaired HRQL in both groups. In this cohort, 65% (n = 160) presented without and 35% (n = 85) with HS, of whom most had NAFLD (n = 65, 76.5%). The HRQL (UI‐value) was significantly lower in PLWH and steatosis (0.86 ± 0.18) in comparison with no steatosis (0.92 ± 0.13). Unemployment (p = 0.025) and waist circumference (p = 0.017) remained independent predictors of a poor HRQL in the steatosis subgroup. In turn, age (p = 0.045), female sex (p = 0.030), body mass index (p = 0.010), and arterial hypertension (p = 0.025) were independent predictors of a low HRQL in the subgroup without steatosis. Conclusion: HS and metabolic comorbidities negatively affect the HRQL. Addressing these factors may improve patient‐reported and liver‐related outcomes in PLWH.

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Hepatic steatosis among people living with HIV in Southern Brazil: prevalence and risk factors

Cited by 5 publications

References 18 publications

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

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

Prevalence and risk factors of nonalcoholic steatohepatitis with significant fibrosis in people with HIV

Effect of hepatic steatosis and associated metabolic comorbidities on health‐related quality of life in people living with HIV

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