Author information
1Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA.
2Division of Infectious Diseases, Department of Medicine and Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
3Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
4Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
5Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
6University of Texas Health Science Center at Houston, Houston, Texas, USA.
7NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, San Diego, CA, USA.
8Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
9Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
10Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
11Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Health, Indianapolis, IN, USA.
12Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Jennifer.Price@ucsf.edu.
Abstract
Background & aims: Food insecurity (FI) is a risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis in the general population, but its impact on liver disease in people with HIV (PWH) is unknown.
Methods: We examined the association of FI with prevalence of NAFLD and fibrosis in a diverse cohort of PWH. PWH aged ≥18 years on antiretroviral therapy, HIV RNA<200 copies/mL, and without other known liver diseases were screened for NAFLD (CAP≥263 decibels/meter) and advanced fibrosis (LSM≥11 kilopascals) by vibration controlled transient elastography at eight US centers. Participants were categorized as food insecure using the Six-Item Short Form Household Food Security Survey. We used multivariable logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) of NAFLD and advanced fibrosis by FI status.
Results: Among 654 PWH, NAFLD was present in 348 (53%) and advanced fibrosis in 41 (6%). FI was present in 203 (31%) of participants, including 97/348 (28%) with NAFLD and 18/41 (44%) with advanced fibrosis. In multivariable analysis, FI was associated with lower odds of NAFLD (OR=0.57,95%CI:0.37-0.88) and a greater, but nonsignificant, odds of advanced fibrosis (OR=1.38,95%CI:0.65-2.90). We identified a significant interaction between FI and diabetes (p=0.02) on fibrosis risk, with a greater odds of fibrosis among food insecure PWH and diabetes (OR=3.83,95%CI:1.15-12.73) but not among food insecure nondiabetics (OR=1.12,95%CI:0.47-2.98).
Conclusions: FI is highly prevalent among PWH and associated with lower odds of NAFLD, and among PWH with diabetes, a greater odds of advanced fibrosis. FI may contribute to hepatic fibrosis through mechanisms other than steatosis in PWH.