Hepatic steatosis in individuals living with HIV measured by controlled attenuation parameter

Sulyok, Mihály; Makara, Mihály; Rupnik, Zsófia; Ferenci, Tamás; Újhelyi, Eszter; Kormos, Luca; Gerlei, Zsuzsanna; Szlávik, János; Horváth, Gábor; Vályi‐Nagy, István

doi:10.1097/meg.0000000000000339

Cited by 24 publications

(18 citation statements)

References 27 publications

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“…BMI, the most important predictor of CAP value in the HIV-infected population (Macías et al, 2014; Macías et al, 2016; Sulyok et al, 2015) showed significant association with LS in the univariate analysis. This association remained considerable according to the result of the BMA.…”

Section: Discussionmentioning

confidence: 87%

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Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Sulyok

Ferenci

Makara

et al. 2017

PeerJ

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BackgroundLiver disease has become an important cause of morbidity and mortality even in those HIV-infected individuals who are devoid of hepatitis virus co-infection. The aim of this study was to evaluate the degree of hepatic fibrosis and the role of associated factors using liver stiffness measurement in HIV mono-infected patients without significant alcohol intake.MethodsWe performed a cross-sectional study of 101 HIV mono-infected patients recruited prospectively from March 1, 2014 to October 30, 2014 at the Center for HIV, St István and St László Hospital, Budapest, Hungary. To determine hepatic fibrosis, liver stiffness was measured with transient elastography. Demographic, immunologic and other clinical parameters were collected to establish a multivariate model. Bayesian Model Averaging (BMA) was performed to identify predictors of liver stiffness.ResultsLiver stiffness ranged from 3.0–34.3 kPa, with a median value of 5.1 kPa (IQR 1.7). BMA provided a very high support for age (Posterior Effect Probability-PEP: 84.5%), moderate for BMI (PEP: 49.3%), CD4/8 ratio (PEP: 44.2%) and lipodystrophy (PEP: 44.0%). For all remaining variables, the model rather provides evidence against their effect. These results overall suggest that age and BMI have a positive association with LS, while CD4/8 ratio and lipodystrophy are negatively associated.DiscussionOur findings shed light on the possible importance of ageing, overweight and HIV-induced immune dysregulation in the development of liver fibrosis in the HIV-infected population. Nonetheless, further controlled studies are warranted to clarify causal relations.

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Section: Discussionmentioning

confidence: 87%

“…Written informed consent was taken from all study participants. The present cross-sectional study is an analysis of data collected for a previous study, with methodology already described (Sulyok et al, 2015). Individuals older than 18 years of age were enrolled after providing their written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Sulyok

Ferenci

Makara

et al. 2017

PeerJ

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“…This CAP cut-off was selected because it has been validated in HIV-uninfected patients and has been used in studies of HS in HIV-infected individuals(5, 8, 10, 12). Kappa coefficient was used to measure agreement between HS diagnosed by CAP or MRS. We used the chi-squared and the Wilcoxon rank-sum tests to compare the characteristics of participants with concordant and discordant MRS and CAP values.…”

Section: Methodsmentioning

confidence: 99%

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

Price¹,

Dodge

Ma³

et al. 2017

Aids

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Objective Hepatic steatosis (HS) is common in HIV-infected individuals. Magnetic resonance spectroscopy (MRS) is the preferred non-invasive method for HS measurement but is expensive. Controlled attenuation parameter (CAP) also assesses HS and is conveniently performed concomitantly with transient elastography. We aimed to assess the accuracy of CAP in the setting of HIV infection. Design Cross-sectional study Methods CAP and MRS were performed in 82 subjects (39 HIV-monoinfected;7 HCV-monoinfected;21 HIV/HCV-coinfected; 15 with neither infection). We used concordance correlation coefficients to compare log-transformed and standardized CAP and MRS values and linear regression to examine factors associated with CAP and MRS-measured HS. The accuracy of CAP to detect ≥mild HS, defined as MRS-liver fat fraction ≥0.05, and the factors associated with discordance between CAP and MRS were evaluated. Results Overall, CAP-HS and MRS-HS correlated moderately well (r=0.60, p<0.001), and correlation was strongest in the HIV-monoinfected group (r=0.67, p<0.001). Body composition factors (higher BMI, waist circumference, visceral and abdominal subcutaneous adipose tissue) and insulin resistance were significantly associated with both greater CAP-HS and MRS-HS. Using a validated CAP cut-off ≥238 decibels/meter, sensitivity and specificity for ≥mild HS were 84% and 75% in the entire cohort; 89% and 80% in the HIV-monoinfected group. Higher body composition parameters were more likely to be misclassified as having HS by CAP. Conclusions Our findings suggest CAP is an acceptable non-invasive surrogate for HS in HIV-infected individuals but may overestimate HS prevalence, especially in individuals with high BMI. Evaluation of factors that improve CAP accuracy and determination of optimal cut-offs are warranted.

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“…La prevalenza di NAFLD nelle persone con infezione da HIV (PLHIV) su biopsie epatiche di pazienti con ipertransaminasemia è risultata elevata (>50%) con un'alta percentuale di NASH (7)(8)(9)(10)(11)(12). Considerando le diagnosi eseguite con metodiche diagnostiche non invasive (ecografia, fibroscan, TAC e risonanza magnetica) la prevalenza di NAFLD si aggira tra il 13% e il 58% nei diversi studi pubblicati (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Tale ampio intervallo di variabilità è giustificato dall'uso di diverse definizioni di NAFLD, dai differenti criteri di selezione dei pazienti e dall'uso di metodiche strumentali non sovrapponibili in termini di sensibilità e specificità.…”

Section: Riassuntounclassified

“…Gli studi basati sulla determinazione del CAP hanno rilevato una prevalenza di steatosi epatica del 39-51,5% (17-19, 37, 38). Il principale fattore di rischio era rappresentato dal BMI (17)(18)(19). Solo due studi hanno escluso i pazienti con abuso alcoolico, mostrando una prevalenza del 36,4-48,0% (37,38).…”

Section: Definizioni E Diagnosiunclassified

La steatosi epatica non alcolica in HIV: una revisione critica della letteratura.

Squillace¹,

Gori²,

Bandera³

2018

JHA

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La steatosi epatica non alcolica in HIV:una revisione critica della letteratura. Non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) in HIV: a critical review. IntroduzioneLa steatosi epatica non alcolica (non alcoholic fatty liver disease, NAFLD) rappresenta una causa emergente di cirrosi e di carcinoma epatocellulare, a causa del diretto legame con l'insorgenza della steatoepatite non alcolica (NASH) (1, 2). La prevalenza di NAFLD nella popolazione generale è influenzata fortemente dall'area geografica di appartenenza, variando dal 7.1% in Nigeria (3) al 42% in Cina (4). Tali variazioni sarebbero imputabili sia a fattori genetici che a differenti regimi dietetici. Obesità, diabete mellito, dislipidemia e sindrome metabolica sono cause note di NAFLD primaria; il ruolo del genere e della razza non sono ancora ben definiti (5), sebbene sia stato rilevato un ruolo significativo del sesso maschile e della razza bianca

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Hepatic steatosis in individuals living with HIV measured by controlled attenuation parameter

Abstract: Our findings reflect the importance of metabolic factors in hepatic steatosis. The strongest independent covariate was BMI.

Cited by 24 publications

References 27 publications

Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

La steatosi epatica non alcolica in HIV: una revisione critica della letteratura.

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