title: Nonalcoholic fatty liver disease among HIV-infected persons.
abstract: 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.
authors.affiliation: HIV Clinic, Naval Medical Center San Diego, San Diego, CA, USA. nancy.crum@med.navy.mil
authors.forename: Nancy
authors.initials: N
authors.lastname: Crum-Cianflone
authors.forename: Angelica
authors.initials: A
authors.lastname: Dilay
authors.forename: Gary
authors.initials: G
authors.lastname: Collins
authors.forename: Dean
authors.initials: D
authors.lastname: Asher
authors.forename: Richard
authors.initials: R
authors.lastname: Campin
authors.forename: Sheila
authors.initials: S
authors.lastname: Medina
authors.forename: Zach
authors.initials: Z
authors.lastname: Goodman
authors.forename: Robin
authors.initials: R
authors.lastname: Parker
authors.forename: Alan
authors.initials: A
authors.lastname: Lifson
authors.forename: Thomas
authors.initials: T
authors.lastname: Capozza
authors.forename: Mary
authors.initials: M
authors.lastname: Bavaro
authors.forename: Braden
authors.initials: B
authors.lastname: Hale
authors.forename: Charles
authors.initials: C
authors.lastname: Hames
mesh_terms: 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