Nonalcoholic fatty liver disease in HIV-infected patients referred to a metabolic clinic: prevalence, characteristics, and predictors.
BACKGROUND
The prevalence and predictors of nonalcoholic fatty liver disease (NAFLD) in human immunodeficiency virus (HIV)-infected highly active antiretroviral therapy-experienced patients and the association of NAFLD with risk of cardiovascular disease and subclinical atherosclerosis are unknown.


METHODS
We performed a cross-sectional observational study. NAFLD was defined by liver-spleen attenuation values of <1.1 on computed tomography in persons who had neither evidence of chronic viral hepatitis nor a significant history of alcohol consumption.


RESULTS
We enrolled 225 patients; 163 (72.4%) were men. Mean (+/-SD) HIV infection duration was 145 +/- 60 months, and mean (+/-SD) body mass index (calculated as weight in kilograms divided by the square of height in meters) was 23.75 +/- 3.59. NAFLD was diagnosed in 83 patients (36.9% of the total cohort). The following variables were significantly associated with NAFLD in univariate analyses: sex, waist circumference, body mass index, cumulative exposure to nucleoside reverse-transcriptase inhibitors, visceral adipose tissue, homeostasis model assessment of insulin resistance index, serum alanine and aspartate aminotransferase levels, and ratios of total serum cholesterol to high-density lipoprotein cholesterol. Coronary artery calcium scores and a diagnosis of diabetes were not associated with NAFLD. In multivariable logistic regression analyses, factors associated (P<0.001) with NAFLD were higher serum alanine to aspartate ratio (odds ratio, 4.59; 95% confidence interval, 2.09-10.08), male sex (odds ratio, 2.49; 95% confidence interval, 1.07-5.81), greater waist circumference (odds ratio, 1.07; 95% confidence interval, 1.03-1.11), and longer nucleoside reverse-transcriptase inhibitor exposure (odds ratio, 1.12 per year of exposure; 95% confidence interval, 1.03-1.22).


CONCLUSIONS
NAFLD is common among HIV-infected persons who have the traditional risk factors for NAFLD (elevations in serum alanine level, male sex, and increased waist circumference) apparent. Exposure to nucleoside reverse-transcriptase inhibitors was an independent risk factor for NAFLD, with an 11% increase in the odds ratio for each year of use.
Guaraldi
Giovanni
G
University of Modena and Reggio Emilia School of Medicine, Modena, Italy. g.guaraldi@unimo.it
Squillace
Nicola
N
Stentarelli
Chiara
C
Orlando
Gabriella
G
D'Amico
Roberto
R
Ligabue
Guido
G
Fiocchi
Federica
F
Zona
Stefano
S
Loria
Paola
P
Esposito
Roberto
R
Palella
Frank
F
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000097:blood; D001837:Body Weights and Measures; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D012307:Risk Factors; D012737:Sex Factors
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D002784:Cholesterol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase