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Abstract Details
Fatty Liver Disease in a Prospective North American Cohort of Adults with HIV and Hepatitis B Coinfection
Mandana Khalili1, Wendy C King2, David E Kleiner3, Mamta K Jain4, Raymond T Chung5, Mark Sulkowski6, Mauricio Lisker-Melman7, David K Wong8, Marc Ghany3, Arun Sanyal9, Richard K Sterling9, HIV-HBV Cohort Study of the Hepatitis B Research Network
Author information
1University of California San Francisco, San Francisco.
2University of Pittsburgh Graduate School of Public Health, Pittsburgh.
3National Institutes of Health, Bethesda.
4UT Southwestern Medical Center, Dallas.
5Massachusetts General Hospital, Boston.
6Johns Hopkins University, Baltimore.
7Washington University School of Medicine, St. Louis.
8University Health Network, Toronto.
9Virginia Commonwealth University, Richmond.
Abstract
Background: Hepatitis B (HBV) and fatty liver disease (FLD) are common etiologies of liver disease in HIV. Correlates of FLD and its relationship with alanine aminotransferase (ALT) overtime were examined in HIV-HBV coinfection.
Methods: From 04/28/14-11/07/18, 114 HIV-HBV adults underwent a liver biopsy and were followed for a median of 3 years (ancillary study of Hepatitis B Research Network). Steatohepatitis was based on presence of steatosis, ballooning and perisinusoidal fibrosis. FLD was defined as ≥5% steatosis and/or steatohepatitis.
Results: Median age was 49 years, 93% were male, 51% black, 93% had HIV RNA<400 copies/mL and 83% HBV DNA<1000 IU/mL. Thirty percent had FLD (20% steatosis, 10% steatohepatitis). Those with FLD had higher median triglyceride (171 versus 100 mg/dL, P<.01) and sdLDL (44 versus 29 mg/dL, P<.01) and lower HDL-2C (9 versus 12 mg/dL, P=.001). After adjusting for age, sex and alcohol use, white and other vs. black race (odds ratio [OR]=8.49 and OR=16.54, respectively, P=.0004), ALT (OR=3.13 per doubling, P=.003), hypertension (OR=10.93, P=.002), hyperlipidemia (OR=4.36, P=.04) and diabetes family history (OR=5.38, P=.02) were independently associated with having FLD. Steatohepatitis or steatosis alone (versus none) were associated with higher ALT overtime (1.93 and 1.34 times higher, respectively; P<.001), with adjustment for age, sex, and HBV DNA.
Conclusions: About 30% with HIV-HBV coinfection had FLD including 10% with steatohepatitis. FLD was associated with non-black race, metabolic risks, an increased atherogenic lipid profile, and elevated ALT overtime. Thus, identification of FLD and management of adverse metabolic profiles is critically important in HIV-HBV coinfection.