Hepatic steatosis in individuals living with HIV measured by controlled attenuation parameter: a cross-sectional study.
OBJECTIVE
Available data on the prevalence of hepatic steatosis in an unselected HIV-infected population are limited. The aim of this study was to determine the prevalence of hepatic steatosis and assess the associated factors in HIV-infected individuals.


METHODS
One hundred and thirty-six HIV-infected individuals were enrolled in this cross-sectional study. Patients underwent transient elastography and controlled attenuation parameter (CAP) measurements. We analyzed the associations between the CAP value and demographic, metabolic, and immunologic parameters. For the first time, in HIV-infected individuals, we used a continuous scale of CAP values to identify significant covariates of hepatic fat accumulation. As a result and compared with other methods, one of the main advantages of CAP was that the quantitative measurement of liver steatosis could be used for analysis.


RESULTS
Using univariate analysis, CAP was significantly correlated with the following continuous variables: CD4 percentage (P=0.035), CD8 percentage (P=0.016), age (P<0.001), CD4/8 ratio (P=0.002), BMI (P<0.001), serum triglyceride (P<0.001), and serum cholesterol (P=0.004) levels, the length of known HIV positivity (P<0.001), and liver stiffness (P=0.041). With respect to categorical variables, a significant association was found for the presence of diabetes (P=0.006), hypertension (P<0.001), facial lipodystrophy (P=0.031), and the use of lopinavir (P=0.042). In multivariate analysis using linear regression, BMI (P<0.001), presence of diabetes (P=0.026), and hypertension (P=0.040) were identified as independent significant correlates. Darunavir therapy was associated negatively with the CAP value (P=0.032).


CONCLUSIONS
Our findings reflect the importance of metabolic factors in hepatic steatosis. The strongest independent covariate was BMI.
aDoctoral School for Clinical Medicine bTransplantation and Surgical Clinic, Semmelweis University cCenter for Hepatology dCenter for HIV eImmunology and Molecular Diagnostics Laboratory, St István and St László Hospital fJohn von Neumann Faculty of Informatics, Óbuda University, Physiological Controls Group gHepatology Center of Buda, Budapest, Hungary.
Mihály
M
Sulyok
Mihály
M
Makara
Zsófia
Z
Rupnik
Tamás
T
Ferenci
Eszter
E
Újhelyi
Luca
L
Kormos
Zsuzsanna
Z
Gerlei
János
J
Szlávik
Gábor
G
Horváth
István
I
Vályi-Nagy
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016516:CD4-CD8 Ratio; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D000069454:Darunavir / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017741:Survivors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
D017320:HIV Protease Inhibitors; D014280:Triglycerides; D002784:Cholesterol; D000069454:Darunavir