Liver fibrosis and fatty liver in Asian HIV-infected patients.
Little is known about the importance of liver fibrosis and fatty liver in HIV-monoinfected individuals without hepatitis virus co-infection, particularly among the Asian population.



To evaluate prevalence and risk factors for liver fibrosis and fatty liver in Asian HIV-monoinfected individuals.



Eighty asymptomatic HIV-monoinfected individuals (tested negative for HBV/HCV) were compared with 160 matched HIV-uninfected healthy controls. Transient elastography and proton-magnetic resonance spectroscopy ((1) H-MRS) were performed to measure liver stiffness and hepatic steatosis respectively. Blood samples were analysed for metabolic profiles and markers of steatohepatitis (e.g. cytokeratin-18).



All HIV-infected individuals (mean ± s.d. age 54 ± 11 years, male 93%, Chinese 94%; diagnosis median duration 8 (IQR 4-13 years) were stable on anti-retrovirals (PI-based 58.7%, NNRTI-based 25.0% integrase-inhibitors 16.3%); diabetes, dyslipidaemia, and metabolic syndrome were common. Fatty liver disease was detected in 28.7%. There was significantly higher degree of liver stiffness [4.9 (IQR 4.1-6.2) kPa vs. 4.2 (IQR 3.6-5.0) kPa, P < 0.001], and greater proportions developed significant fibrosis (7.0 kPa, 14.3% vs. 3.1%, P = 0.001) and cirrhosis (10.3 kPa, 5.2% vs. 0.6%, P = 0.040) compared with controls. HIV infection was an independent risk factor for significant fibrosis (adjusted OR 4.00, 95% CI 1.29-12.41, P = 0.016). HIV-infected individuals with fatty liver had excessive liver stiffness and fibrosis. Two cases of asymptomatic hepatocellular carcinoma were detected.



HIV-monoinfected patients are at risk for liver fibrosis and cirrhosis. HIV-related mechanisms and fatty liver disease may play important roles. Screening and intervention to prevent severe outcomes should be considered.
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
G
G
Lui
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.|Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
V W-S
VW
Wong
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.|Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
G L-H
GL
Wong
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong.
W C-W
WC
Chu
Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong.
C-K
CK
Wong
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
I M H
IM
Yung
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
R Y K
RY
Wong
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
S-L
SL
Yeung
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong.
D K-W
DK
Yeung
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
C S K
CS
Cheung
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
H-Y
HY
Chan
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.|Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
H L-Y
HL
Chan
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.|Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong.
N
N
Lee
D000328:Adult; D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D016022:Case-Control Studies; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D053538:Keratin-18 / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors
D015415:Biomarkers; C488421:KRT18 protein, human; D053538:Keratin-18