Nonalcoholic fatty liver disease among HIV-infected persons.
OBJECTIVE
To describe the prevalence and factors associated with nonalcoholic fatty liver disease (NAFLD) among HIV-infected persons not infected with hepatitis C virus (HCV).


METHODS
: A cross-sectional study among HIV-infected patients in a large HIV clinic.


METHODS
NAFLD was defined as steatosis among patients without viral hepatitis (B or C) coinfection or excessive alcohol use. The prevalence of NAFLD was identified by ultrasound examination evaluated by 2 radiologists blinded to the clinic information; liver biopsies were performed on a subset of the study population. Factors associated with NAFLD were evaluated by proportional odds logistic regression models.


RESULTS
Sixty-seven of 216 patients (31%) had NAFLD based on ultrasound evaluation. Among those with NAFLD, steatosis was graded as mild in 60%, moderate in 28%, and severe/marked in 12%. Factors associated with the degree of steatosis on ultrasound examination in the multivariate model included increased waist circumference [odds ratio (OR) 2.1 per 10 cm, P < 0.001], elevated triglyceride levels (OR 1.2 per 100 mg/dL, P = 0.03), and lower high-density lipoprotein levels (OR 0.7, per 10 mg/dL, P = 0.03). African Americans were less likely to have NAFLD compared with whites (14% vs. 35%), although this did not reach statistical significance (OR 0.4, P = 0.08). Similar associations were noted for the subset of patients diagnosed by liver biopsy. CD4 cell count, HIV viral load, duration of HIV infection, and antiretroviral medications were not independent risk factors associated with NAFLD after adjustment for dyslipidemia or waist circumference.


CONCLUSIONS
NAFLD was common among this cohort of HIV-infected HCV-seronegative patients. NAFLD was associated with a greater waist circumference, low high-density lipoprotein, and high triglyceride levels. Antiretroviral medications were not associated with NAFLD; prospective studies are needed to confirm this finding.
Crum-Cianflone
Nancy
N
HIV Clinic, Naval Medical Center San Diego, San Diego, CA, USA. nancy.crum@med.navy.mil
Dilay
Angelica
A
Collins
Gary
G
Asher
Dean
D
Campin
Richard
R
Medina
Sheila
S
Goodman
Zach
Z
Parker
Robin
R
Lifson
Alan
A
Capozza
Thomas
T
Bavaro
Mary
M
Hale
Braden
B
Hames
Charles
C
D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014463:Ultrasonography