title: Clinical, biochemical and histological differences between HIV-associated NAFLD and primary NAFLD: a case-control study.
abstract: BACKGROUND
  There are limited data regarding the clinical, biochemical and liver histological characteristics of patients with HIV-associated nonalcoholic fatty liver disease (NAFLD), and whether this entity differs in presentation and severity from primary NAFLD AIM: To examine the clinical and histological differences between HIV-associated NAFLD and primary NAFLD.
  
  
  METHODS
  This is a cross-sectional, case-control study comparing patients with HIV-associated NAFLD vs. patients with primary NAFLD. HIV-infected patients were identified from a database of consecutive liver biopsies performed at the University of California at San Diego, over a 13-year period. HIV-infected patients with biopsy-proven NAFLD were selected as cases, after exclusion of other causes of liver disease and hepatic steatosis. Age-sex-matched controls with biopsy-proven primary NAFLD were randomly identified from the same pathology database. All biopsies underwent a standardised, detailed, histological research evaluation by a liver pathologist who was blinded to clinical and case-control status.
  
  
  RESULTS
  Compared to age-sex-matched patients with primary NAFLD (n = 33), patients with HIV-associated NAFLD (n = 33) had significantly higher mean aspartate aminotransferase (P < 0.001), alanine aminotransferase (P < 0.001), alkaline phosphatase (P = 0.003) and serum triglycerides (P = 0.024). Similarly, compared to age-sex-matched primary NAFLD, patients with HIV-associated NAFLD had significantly higher rates of definite steatohepatitis (37% vs. 63%, P = 0.04), and more features of liver injury, including lobular inflammation (<0.001) and acidophil bodies (<0.001).
  
  
  CONCLUSIONS
  Compared to age-sex-matched primary NAFLD, HIV-associated NAFLD has increased severity of liver disease and a higher prevalence of NASH.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Vodkin
authors.forename: M A
authors.initials: MA
authors.lastname: Valasek
authors.forename: R
authors.initials: R
authors.lastname: Bettencourt
authors.forename: E
authors.initials: E
authors.lastname: Cachay
authors.forename: R
authors.initials: R
authors.lastname: Loomba
mesh_terms: D000328:Adult; D001706:Biopsy; D015992:Body Mass Index; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000453:epidemiology / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006305:Health Status Indicators; D006801:Humans; D007249:Inflammation / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence