Prevalence and risk factors of nonalcoholic fatty liver disease in HIV-monoinfection

Maurice, James; Patel, Amee B.; Scott, Alasdair; Patel, Krish; Thursz, Mark; Lemoine, Maud

doi:10.1097/qad.0000000000001504

Cited by 184 publications

(236 citation statements)

References 27 publications

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“…In addition, many studies report data on liver health among HIV populations with significant exposure to ART. (5,8,14,22,28,30,31) Most studies have identified traditional risk factors for abnormal liver enzymes in patients with HIV mono-infection such as metabolic syndrome (7,32) and some have found an association with HIV-related factors such as increased HIV viral load and exposure to certain antiretrovirals. (8,33) While the APRI and FIB-4 were not always in agreement, our baseline analysis identified key variables known to be associated with an increased risk of liver fibrosis, including older age, male gender, black race, abnormal ALT, co-infection with hepatitis and a history of known liver disease.…”

Section: Discussionmentioning

confidence: 99%

“…Liver disease remains a major cause of morbidity and mortality in human immunodeficiency virus (HIV)‐infected individuals globally and is highest among those with concurrent alcohol use and/or hepatitis B and C virus coinfection . However, nonalcoholic fatty liver disease (NAFLD), which is frequently associated with metabolic syndrome, has an increased prevalence among HIV‐monoinfected individuals as well . While NAFLD most commonly causes simple steatosis, it can also progress to nonalcoholic steatohepatitis, fibrosis, and/or cirrhosis .…”

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confidence: 99%

“…which is frequently associated with metabolic syndrome, (6) has an increased prevalence among HIVmonoinfected individuals as well. (7,8) While NAFLD most commonly causes simple steatosis, it can also progress to nonalcoholic steatohepatitis, fibrosis, and/ or cirrhosis. (6) A recent meta-analysis reported that the prevalence of NAFLD (by imaging) was 35%, (7) compared with 25% in the general population.…”

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Benefit of Early versus Deferred Antiretroviral Therapy on Progression of Liver Fibrosis among People with HIV in the START Randomized Trial

et al. 2019

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The role of antiretroviral therapy (ART) in reducing or contributing to liver fibrosis in persons with human immunodeficiency virus (HIV) is unclear. We evaluated participants in the Strategic Timing of AntiRetroviral Treatment (START) trial for liver fibrosis using the AST to Platelet Ratio Index (APRI) and Fibrosis‐4 Index (FIB‐4), and assessed for a benefit of early versus delayed ART on liver fibrosis progression. ART‐naïve persons with high CD4 counts (>500 cells/µL) from 222 clinical sites in 35 countries were randomized to receive ART either at study enrollment (immediate treatment arm) or when their CD4 count fell below 350 cells/µL (deferred treatment arm). The following outcomes were evaluated: fibrosis (APRI > 0.5 or FIB‐4 > 1.45), significant fibrosis (APRI > 1.5 or FIB‐4 > 3.25), hepatic flare, and resolution of elevated APRI and FIB‐4 scores. Of the 4,684 enrolled into the START study, 104 did not have APRI or FIB‐4 results and were excluded. Among 4,580 participants (2,273 immediate treatment; 2,307 deferred treatment), the median age was 36 years, 26.9% were female, and 30.4% were black. Three percent had an alcoholism or substance abuse history, 6.4% had hepatitis B and/or C, and 1.1% had significant fibrosis at baseline. The median CD4 count was 651, and 5.3% had HIV RNA ≤ 200. Immediate arm participants were at lower risk of developing increased fibrosis scores than deferred arm participants (hazard ratio [HR] = 0.66; 95% confidence interval [CI] = 0.57‐0.78; P < 0.001) and more likely to have resolution of elevated baseline scores (HR 1.6; 95% CI 1.3‐1.9; P < 0.001). Conclusions: Significant liver fibrosis was rare among ART‐naïve HIV‐positive persons with high CD4 counts. Our findings suggest a benefit of early ART in preventing the development of liver fibrosis.

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Benefit of Early versus Deferred Antiretroviral Therapy on Progression of Liver Fibrosis among People with HIV in the START Randomized Trial

et al. 2019

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“…However, even in the absence of viral hepatitis, liver injury caused by alcohol and nonalcoholic fatty liver disease (NAFLD) is common and may be more severe in PLWH . Indeed, NAFLD has been reported in up to 35% of PLWH and is expected to become the leading cause of cirrhosis in this population . Emerging data suggest that alterations in the gut microbiome, a diverse microbial community residing in the gastrointestinal tract, may play a key role in chronic liver disease progression in PLWH.…”

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confidence: 99%

The Pathogenesis of Liver Disease in People Living With Human Immunodeficiency Virus: The Emerging Role of the Microbiome

Kardashian

Peters

Tien

et al. 2020

Clinical Liver Disease

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“…

upon-Tyne, UKSir, Nonalcoholic fatty liver disease (NAFLD) is common in people living with HIV (PLWH) [1]. A recent update to European guidance suggests screening for NAFLD in PLWH who also have metabolic syndrome (MetS) [2].

…”

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Central obesity and nonalcoholic fatty liver disease in people living with HIV: a case for targeted screening?

et al. 2018

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Prevalence and risk factors of nonalcoholic fatty liver disease in HIV-monoinfection

Cited by 184 publications

References 27 publications

Benefit of Early versus Deferred Antiretroviral Therapy on Progression of Liver Fibrosis among People with HIV in the START Randomized Trial

Benefit of Early versus Deferred Antiretroviral Therapy on Progression of Liver Fibrosis among People with HIV in the START Randomized Trial

The Pathogenesis of Liver Disease in People Living With Human Immunodeficiency Virus: The Emerging Role of the Microbiome

Central obesity and nonalcoholic fatty liver disease in people living with HIV: a case for targeted screening?

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