Nonalcoholic fatty liver disease increases metabolic risk in patients with HIV
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People living with HIV who also have nonalcoholic fatty liver disease are at greater risk for incident diabetes and dyslipidemia, according to results from a retrospective analysis.
“Nonalcoholic fatty liver disease (NAFLD) is the most frequent liver disease in the general population globally and contributes to the development of type 2 diabetes mellitus, dyslipidemia and hypertension, all comorbidities that increase cardiovascular risk,” Thomas Krahn, MD, of McGill University Health Centre, told Healio. “Liver disease and cardiovascular disease are primary causes of non-AIDS-related morbidity and mortality in people with HIV (PWH). NAFLD is not only more prevalent in this population; it has been shown to progress to fibrosis more quickly. However, the effect of NAFLD on the development of diabetes and other metabolic comorbidities is not known.”
Krahn and colleagues assessed the impact of NAFLD on the development of metabolic comorbidities in PWH using the LIVEr in HIV, or LIVEHIV, cohort. PWH were consecutively screened for liver disease, including hepatitis C virus and hepatitis B virus serology; they also took the Alcohol Use Disorders Identification Test and underwent annual measurements of transient elastography with FibroScan (Echosens). NAFLD was classified as a controlled attenuation parameter of greater than or equal to 248 dB/m and the exclusion of other liver diseases. Incident diabetes, hypertension, dyslipidemia and chronic kidney disease were also examined.
According to the study, 485 patients from the LIVEHIV cohort were followed for a median of 40.1 months. The presence of NAFLD at baseline was 38.1%. Severe hepatic steatosis was present in 16.7% of patients; 14.8% of patients were suspected to have significant liver fibrosis and 2.5% were thought to have cirrhosis.
Patients with NAFLD were older and more likely to be white. BMI was also higher in these patients and a greater period of time had passed since their HIV diagnosis.
Rates of diabetes (4.74; 95% CI, 3.09-7.27) and dyslipidemia (8.16; 95% CI, 5.42-12.27) were higher in patients with NALFD compared with those without NAFLD (diabetes: 0.87; 95% CI, 0.42-1.83 per 100 person-years; dyslipidemia: 3.99; 95% CI, 2.67-5.95 per 100 person-years). NAFLD served as an independent predictor for the development of diabetes (adjusted HR, 5.13; 95% CI, 2.14-12.31) and dyslipidemia (aHR, 2.35; 95% CI, 1.34-4.14) on multivariable analyses.
“The demonstration that NAFLD predicts the development of type 2 diabetes mellitus and dyslipidemia supports a central role of NAFLD as a barometer of metabolic health and a contributor to cardiovascular risk in people with HIV,” Krahn concluded. “Screening for NAFLD in people with HIV may lead to better risk stratification, referral strategies and treatment of comorbidities to prevent end-stage cardiovascular and liver disease in this population.” – by Caitlyn Stulpin
Reference:
Krahn T, et al. J Infect Dis. 2020;doi:10.1093/infdis/jiaa170.
Disclosures: Krahn reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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