title: Incidence of liver damage of uncertain origin in HIV patients not co-infected with HCV/HBV.
abstract: OBJECTIVE
  Several studies have reported that a significant number of HIV patients not co-infected with HCV/HBV develop liver damage of uncertain origin (LDUO). The objective of our study was to evaluate the incidence of and risk factors for the development of LDUO in HIV infected patients not co-infected with HCV/HBV.
  
  
  METHODS
  Prospective longitudinal study that included HIV-infected patients free of previous liver damage and viral hepatitis B or C co-infections. Patients were followed up at 6-monthly intervals. Liver stiffness was measured at each visit. Abnormal liver stiffness (ALS) was defined as a liver stiffness value greater than 7.2 kPa at two consecutive measurements. For patients who developed ALS, a protocol was followed to diagnose the cause of liver damage. Those patients who could not be diagnosed with any specific cause of liver disease were diagnosed as LDUO and liver biopsy was proposed.
  
  
  RESULTS
  210 patients matched the inclusion criteria and were included. 198 patients completed the study. After a median (Q1-Q3) follow-up of 18 (IQR 12-26) months, 21 patients (10.6%) developed ALS. Of these, fifteen patients were diagnosed as LDUO. The incidence of LDUO was 7.64 cases/100 patient-years. Histological studies were performed on ten (66.6%) patients and all showed liver steatosis. A higher HOMA-IR value and body mass index were independently associated with the development of LDUO.
  
  
  CONCLUSIONS
  We found a high incidence of LDUO in HIV-infected patients associated with metabolic risk factors. The leading cause of LDUO in our study was non-alcoholic fatty liver disease.
authors.affiliation: Infectious Diseases Unit, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, Cordoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero-Juárez
authors.forename: Angela
authors.initials: A
authors.lastname: Camacho
authors.forename: Nicolás
authors.initials: N
authors.lastname: Merchante
authors.forename: Inés
authors.initials: I
authors.lastname: Pérez-Camacho
authors.forename: Juan
authors.initials: J
authors.lastname: Macias
authors.forename: Carmen
authors.initials: C
authors.lastname: Ortiz-Garcia
authors.forename: Celia
authors.initials: C
authors.lastname: Cifuentes
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: José
authors.initials: J
authors.lastname: Peña
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005234:Fatty Liver / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology