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HIV increases risk for liver fibrosis
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In a case-control study, Asian patients with HIV without hepatitis B or C virus infection showed high rates of liver fibrosis and fatty liver compared with patients without HIV.
“In the era of antiretroviral therapy, noninfective complications have become a major clinical challenge that doctors need to be vigilant for,” Nelson Lee, MD, MBBS, FRCP, FHKCP, FHKAM, head of the division of infectious diseases, department of medicine and therapeutics, The Chinese University of Hong Kong, told Infectious Disease News. “The message we want to convey is that advanced liver fibrosis, cirrhosis and even liver cancer can occur in patients with HIV infection despite adequate viral suppression by antiretroviral therapy and restoration of CD4 cell counts.”
Nelson Lee
Lee and colleagues compared results from transient elastography and proton-magnetic resonance spectroscopy tests of 80 asymptomatic HIV-monoinfected patients — negative for HBV or HCV — with 160 matched HIV-uninfected healthy controls. The researchers sought to determine differences in liver stiffness and hepatic steatosis.
Among the HIV-infected patients, 28.7% had fatty liver disease, which was comparable to controls (27.5%). In those with fatty liver, more severe liver injury was observed with evidence of significant fibrosis (27.3%) and cirrhosis (9.1%). A greater degree of liver stiffness (4.9 kPa) was found in these patients compared with the controls (4.2 kPa). In addition, more HIV-infected patients developed significant fibrosis (14.3% vs. 3.1%; P = .001) and cirrhosis (5.2% vs. 0.6%; P = .04) compared with the controls, absent of viral hepatitis or alcohol consumption.
“Our results suggest that fatty liver disease may be another important etiology for liver fibrosis in HIV-monoinfected patients. Although prevalence of fatty liver was not shown to be higher among the HIV-infected with this cohort, there was excessive liver stiffness if fatty liver was present,” the researchers wrote.
Multivariate analysis showed HIV infection (adjusted OR = 4; 95% CI, 1.29-12.41) and central obesity (adjusted OR = 6.14; 95% CI, 1.99-18.93) were independent factors associated with significant fibrosis, after adjustment for certain variables.
“This is consistent with a large case-control study performed in Uganda, which showed that HIV infection was linked to increased risk of liver fibrosis,” Lee and colleagues wrote.
“HIV-related mechanisms and fatty liver disease may play important roles, which deserve further investigation,” the researchers concluded. “Better screening programs, particularly among patients with metabolic comorbidities, accompanied by appropriate interventions to prevent fatty liver and severe liver outcomes should be considered.” – by Melinda Stevens
Disclosure: Lee reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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