Non-viral liver disease burden in HIV-monoinfected individuals: a longitudinal observational retrospective cohort study.
Recent advances in antiviral therapy have improved outcomes in HIV-positive individuals co-infected with hepatitis B and C virus (HBV/HCV). Our aim was to assess prevalence and predictors of chronic liver disease (CLD) due to the metabolic syndrome (MS), alcohol and antiretrovirals (ARVs) use in HIV-monoinfected individuals. This was a retrospective cohort study (2005-2012). HIV-positive patients with negative HBV/HCV serology and at least two elevated alanine aminotransferase (ALT) levels six months apart were included. Data are presented as mean ± SD or percentage. Despite negative viral serology, 27% (1047/3872) of HIV-positive individuals had persistently elevated ALT. Only 243 (23.2%) were investigated (by imaging in the majority, only 58 undergoing liver biopsy/transient elastography). CLD was identified in 66.2%, this being clinically significant in one in four individuals. Potential CLD risk factors were alcohol (44.2%), hepatotoxic ARVs (74.1%) and MS risk factors (68%) with 68.7% having >1 risk factor. On multivariate logistic regression analysis serum triglyceride (OR 1.482, 95% CI 1.053-2.086, p = .024) was the only independent predictor of CLD. Overall, 4.3% were referred to Hepatology services. In conclusion, less than 6% of HIV-monoinfected individuals with persistently elevated ALT undergo objective assessment of hepatic fibrosis. Despite non-stringent criteria, some degree of non-viral CLD is identified in approximately two-thirds of those investigated, risk factors being synonymous with those for the MS. This increasing yet under-recognised non-viral CLD burden warrants timely recognition to prevent long-term morbidity and mortality.
a Deparment of Gastroenterology and Hepatology , Brighton and Sussex University Hospital , East Sussex , UK.
Natalie F
NF
Shur
a Deparment of Gastroenterology and Hepatology , Brighton and Sussex University Hospital , East Sussex , UK.
Yishi
Y
Tan
b Clinical Investigation and Research Unit, Brighton and Sussex University Hospital , East Sussex , UK.
Stephanie
S
Goubet
c Department of HIV/Genitourinary Medicine , Brighton and Sussex University Hospital, Brighton and Sussex University Hospital , East Sussex , UK.|d Department of Medicine , Brighton and Sussex Medical School , Brighton , UK.
Martin
M
Fisher
c Department of HIV/Genitourinary Medicine , Brighton and Sussex University Hospital, Brighton and Sussex University Hospital , East Sussex , UK.
Yvonne
Y
Gilleece
a Deparment of Gastroenterology and Hepatology , Brighton and Sussex University Hospital , East Sussex , UK.|d Department of Medicine , Brighton and Sussex Medical School , Brighton , UK.
Sumita
S
Verma
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000437:Alcoholism / Q000150:complications*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D019380:Anti-HIV Agents; D014280:Triglycerides; D000410:Alanine Transaminase
Chronic liver disease; alcohol use; antiretroviral therapy; fatty liver; metabolic syndrome