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Abstract Details
Increased Body Mass Index and Type 2 Diabetes Are the Main Predictors of Nonalcoholic Fatty Liver Disease and Advanced Fibrosis in Liver Biopsies of Patients With Human Immunodeficiency Virus Monoinfection
Clin Infect Dis. 2021 Oct 5;73(7):e2184-e2193. doi: 10.1093/cid/ciaa1302.
James B Maurice12, Robert Goldin3, Andrew Hall4, Jennifer C Price5, Giada Sebastiani67, Caryn G Morse8, Laura Iogna Prat2, Hugo Perazzo9, Lucy Garvey10, Patrick Ingiliz11, Giovanni Guaraldi12, Emmanouil Tsochatzis213, Maud Lemoine1
Author information
1Department of Metabolism, Digestion, and Reproduction, Section of Hepatology, St Mary's Hospital, Imperial College London, London, United Kingdom.
2Department of Hepatology, Royal Free Hospital NHS Trust, London, United Kingdom.
3Department of Histopathology, Imperial College Healthcare NHS Trust, London, United Kingdom.
4Department of Histopathology, Royal Free Hospital NHS Trust, London, United Kingdom.
5Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
6Chronic Viral Illness Service, McGill University Health Centre (MUHC), Montreal, Quebec, Canada.
7Division of Gastroenterology and Hepatology, MUHC, Montreal, Quebec, Canada.
8Department of Infectious Disease, Wake Forest Baptist Medical Centre, Winston-Salem, North Carolina, USA.
9National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
10Department of Infectious Disease, Imperial College Healthcare NHS Trust, London, United Kingdom.
11Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany.
12Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
13Institute for Liver and Digestive Health, University College London, London, United Kingdom.
Abstract
Background: Liver disease is an important cause of morbidity and mortality in people living with human immunodeficiency virus (PLWH), of which nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized cause. There are limited data investigating NAFLD in HIV monoinfection and histologically defined disease. We aimed to identify who is at risk of fibrosis, NAFLD, and nonalcoholic steatohepatitis (NASH) among PLWH and explore the diagnostic accuracy of noninvasive markers of fibrosis.
Methods: This was a retrospective, cross-sectional, international, multicenter study including patients with HIV monoinfection, without chronic viral hepatitis or other known causes of chronic liver disease, who underwent liver biopsy for abnormal liver biochemistry and/or clinical suspicion of liver fibrosis.
Results: A total of 116 patients from 5 centers were included. Sixty-three (54%) had NAFLD, of whom 57 (92%) had NASH. Overall, 36 (31%) had advanced fibrosis (≥F3) and 3 (3%) had cirrhosis. Of the 53 cases without NAFLD, 15 (28%) had advanced fibrosis. Collagen proportionate area was similar between cases with and without NAFLD (3% vs 2%). Body mass index was independently associated with NAFLD (aOR, 1.2; 95% CI, 1.08-1.34), and type 2 diabetes was independently associated with advanced fibrosis (aOR, 3.42; 95% CI, 1.00-11.71). The area under the curve for advanced fibrosis was 0.65 and 0.66 for both NAFLD Fibrosis Score (NFS) and FIB-4. Cutoff values of -1.455 (NFS) and 1.3 (FIB-4) have negative-predictive values of 0.80 and 0.82, respectively.
Conclusions: Advanced fibrosis is strongly associated with type 2 diabetes in PLWH. Serological markers require further optimization.