Predictive factors associated with liver fibrosis and steatosis by transient elastography in patients with HIV mono‐infection under long‐term combined antiretroviral therapy

Perazzo, Hugo; Cardoso, Sandra Wagner; Yanavich, Carolyn; Nunes, Estêvão Portela; Morata, Michelle; Gorni, Nathalia; Silva, Paula Simplício da; Cardoso, Cibele C.; Almeida, Cristina; Luz, Paula M.; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.1002/jia2.25201

Cited by 55 publications

(60 citation statements)

References 41 publications

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“…In our cohort, we can confirm a high prevalence of severe hepatic steatosis of 41% in HIV patients compared to the general population, where NAFLD affects 25% of the population . This is in line with many previous studies and underlines the robustness of our data …”

Section: Discussionsupporting

confidence: 92%

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Fibroblast growth factor 21 is independently associated with severe hepatic steatosis in non‐obese HIV‐infected patients

Praktiknjo

Natalie

Mohr

et al. 2019

Liver International

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Background: Severe hepatic steatosis shows a high prevalence and contributes to morbidity and mortality in human immunodeficiency virus (HIV) infected patients.Known risk factors include obesity, dyslipidaemia and features of metabolic syndrome. Fibroblast growth factor 21 (FGF-21) is involved with hepatic glucose and lipid metabolism. This study aimed to evaluate FGF-21 as a biomarker for severe hepatic steatosis in non-obese HIV-infected patients.Methods: This is a prospective, cross-sectional, monocentric study including HIV-infected out-patients. Hepatic steatosis was measured via controlled attenuation parameter (CAP) using FibroScan 502 touch (ECHOSENS, France). Severe hepatic steatosis was defined at CAP ≥ 253 dB/m. Peripheral blood samples were collected and plasma was analysed for FGF-21. Demographic and clinical characteristics were collected from patient's health records. Results:In total, 73 non-obese HIV-monoinfected patients were included in this study. Prevalence of severe hepatic steatosis was 41%. Patients with severe hepatic steatosis showed significantly higher levels of FGF-21. Univariate analysis revealed FGF-21, BMI, hyperlipidaemia, ALT levels and arterial hypertension as significant, while multivariate analysis showed only FGF-21, arterial hypertension and ALT levels as significant independent risk factors for severe hepatic steatosis. Conclusion:This study presents FGF-21 as an independent and stronger predictor of severe hepatic steatosis than blood lipids in HIV-infected patients. Moreover, arterial hypertension and ALT levels predict severe steatosis even in non-obese HIV-monoinfected patients. Furthermore, this study supports existing metabolic risk factors and expands them to non-obese HIV-infected patients. | 1515PRAKTIKNJO eT Al. | INTRODUC TI ONPatients with human immunodeficiency virus (HIV) infection nowadays can be treated effectively with combined antiretroviral therapy (cART), which can efficiently suppress virus replication and improve survival. However, hepatic steatosis is a growing health care burden not only in the general population but also especially in the high prevalence risk group of HIV-infected patients. 1,2 In some patients, hepatic steatosis can progress to non-alcoholic steatohepatitis (NASH), a condition including inflammation and fibrosis, contributing to morbidity and mortality. 3 In a recent meta-analysis prevalence of non-alcoholic fatty liver disease (NAFLD) in HIV-infected patients was 35%, while prevalence of NASH was 42%. 4 Up to 22% of hepatocellular carcinoma (HCC) as life-threatening complication are now attributed to NASH. 5,6 HIV infection itself is implicated in the development of metabolic disorders. 7 The degree of HIV viremia has been associated with hypertriglyceridemia, dyslipidaemia, and insulin resistance in patients with untreated HIV and HIV-associated mitochondrial damage has been implicated in systemic immune activation in the pathogenesis of diabetes. 8-10 Moreover, HIV promotes hepatic steatosis by interacting with sterol regulatory...

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Section: Discussionsupporting

confidence: 92%

“…Importantly, risk factors for hepatic steatosis are similar in HIV‐infected patients and general population, namely obesity, dyslipidaemia and features of metabolic syndrome . However, co‐infection with certain genotypes of HCV are reported to cause hepatic steatosis .…”

Section: Discussionmentioning

confidence: 99%

Fibroblast growth factor 21 is independently associated with severe hepatic steatosis in non‐obese HIV‐infected patients

Praktiknjo

Natalie

Mohr

et al. 2019

Liver International

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“…From the results of our study, the independent predictors of NAFLD were high BMI, advance age, and serum TG level higher than 150 mg/dL which are similar to the results from the previous studies [12,[14][15][16]28]. Screening for the presence of NAFLD in HIV patients who have these factors is useful for early detection of NAFLD in these patients.…”

Section: Discussionsupporting

confidence: 89%

“…A recent metaanalysis study of 10 moderate to low quality articles using different methods to assess hepatic steatosis demonstrated that the prevalence of NAFLD was 35% (95%CI, 29-42) [14]. CAP at least 248 dB/m was used to define NAFLD in this study, similarly to the previous studies [15,20]. However, using various cutoffs values for NAFLD may lead to a wide range of prevalence of NAFLD in HIVinfected population [16,28,30].…”

Section: Discussionmentioning

confidence: 51%

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Prevalence and predicting factors of non-alcoholic fatty liver disease diagnosed by transient elastography with controlled attenuation parameter in HIV-infected patients

Jongraksak

Sobhonslidsuk

Jatchavala

et al. 2019

Preprint

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Background: HIV infection is one of the most important health problems worldwide. With effective antiretroviral therapy (ART), the mortality rate of HIV-infected patients has significantly declined. Currently, metabolic complications become more common and lead to increasing morbidity and mortality in HIV-infected patients. Non-alcoholic fatty liver disease (NAFLD) has emerged as a common metabolic complication in these patients. Our study was aimed to determine the prevalence and predicting factors of NAFLD in HIV-infected population.Methods: A cross-sectional study was conducted in HIV-infected patients receiving ART without history of regular alcohol consumption or known chronic liver diseases. The data of demographic and clinical parameters, metabolic profiles, bioelectrical impedance analysis, liver ultrasonography and transient elastography (TE) with controlled attenuation parameter (CAP) were collected. The prevalence and predicting factors of NAFLD were analyzed. NAFLD was defined when CAP ≥248 dB/m. Patients were categorized into two groups: NAFLD and non-NAFLD. Significant liver fibrosis was defined when liver stiffness measurement (LSM) >7.0 kPa. Predicting factors of NAFLD were determined using logistic regression analysis.Results: A total of 150 patients were included in the study. Forty-eight (32.0%) patients had NAFLD. Among this group, significant fibrosis was diagnosed in 5 (10.4%) patients and steatosis by ultrasonography was documented in 31 (64.6%) patients. Baseline characteristics including age, sex, CD4 cell count, types of ART regimens and duration of ART between the two groups were not different (p>0.05). Blood pressure, waist circumference, body mass index (BMI), percentage of fat, AST, ALT, HbA1c, LDL, and triglycerides were higher in the NAFLD group (p<0.05). By multivariate analysis, high BMI [odds ratio (OR) 1.596; 95% confidence interval (CI), 1.336-1.907, p<0.001], triglycerides level more than 150 mg/dl [OR 3.722; 95% CI, 1.508-9.187, p<0.004] and advance age [OR 1.076; 95% CI, 1.017-1.139, p<0.011] were predicting factors of NAFLD. Conclusions: NAFLD is commonly found in HIV-infected patients receiving ART while significant fibrosis is relatively uncommon. High BMI, age and triglycerides appear to be predicting factors of NAFLD. The regimen and duration of ART are not associated with NAFLD. Screening for NAFLD by TE with CAP in HIV-infected patients should be recommended for early detection of NAFLD.

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New Drugs for NASH and HIV Infection: Great Expectations for a Great Need

et al. 2020

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on behalf of the SHIVER Network In recent years, there has been an increasing number of clinical trials for the treatment of nonalcoholic steatohepatitis (NASH). People living with human immunodeficiency virus (PLWH) are commonly excluded from these studies, usually due to concerns over drug-drug interactions associated with antiretroviral therapy. The Steatohepatitis in HIV Emerging Research Network, a group of international experts in hepatology and infectious diseases, discusses our current understanding on the interaction between human immunodeficiency virus and NASH, and the issues related to the inclusion of PLWH in NASH clinical trials. Recent trials addressing NASH treatment in PLWH are discussed. The risk of drug-drug interactions between antiretroviral therapy and aramchol, cenicriviroc, elafibranor, obeticholic acid and resmetirom (MGL-3196), which are currently in phase 3 trials for the treatment of NASH, are reviewed. A model for trial design to include PLWH is proposed, strongly advocating for the scientific community to include this group as a subpopulation within studies. (Hepatology 2020;71:1831-1844).

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Predictive factors associated with liver fibrosis and steatosis by transient elastography in patients with HIV mono‐infection under long‐term combined antiretroviral therapy

Cited by 55 publications

References 41 publications

Fibroblast growth factor 21 is independently associated with severe hepatic steatosis in non‐obese HIV‐infected patients

Fibroblast growth factor 21 is independently associated with severe hepatic steatosis in non‐obese HIV‐infected patients

Prevalence and predicting factors of non-alcoholic fatty liver disease diagnosed by transient elastography with controlled attenuation parameter in HIV-infected patients

New Drugs for NASH and HIV Infection: Great Expectations for a Great Need

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