Prevalence and predictors of liver steatosis and fibrosis in unselected patients with HIV mono-infection.
OBJECTIVE
Significant liver disease may develop in HIV mono-infected patients, usually associated with fatty liver and/or cART exposure. We estimated the prevalence and predictors of hepatic steatosis and fibrosis as assessed by ultrasound and transient elastography (TE).


METHODS
We enrolled 125 consecutive HIV mono-infected patients who underwent ultrasound and TE. Clinical, biochemical, immunological, virological features and medication history were analysed.


RESULTS
Mean age was 39.5±10.3years and 91% were male. Metabolic syndrome (MS) was present in 9.8%, diabetes in 5.6%, hypertension in 9.7%, dyslipidemia in 32.8%. Increased AST and ALT were found in 5.6% and 16.8% respectively. Eighty-five (68%) patients were on cART (median length of treatment of 3 years, IQR 0-17). Hepatic steatosis was detected in 61 (55%) patients and was independently associated with male sex (OR 14.6, 95% CI 1.44-148.17), age (OR 1.082, 95% CI 1.01-1.16), HOMA (OR 2.56, 95% CI 1.101-5.96) and GGT (OR 1.037, 95% CI 1.007-1.075). Significant fibrosis (stiffness>7.4kPa) was present in 22 patients (17.6%) and was significantly associated with MS (OR 3.99, 95% CI 1.001-16.09).


CONCLUSIONS
Liver fibrosis can develop in asymptomatic HIV mono-infected patients. This is likely associated with NAFLD and usually manifests with normal transaminases. Non-invasive screening for the presence of NAFLD and fibrosis should be considered in the routine care of such patients.
Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
Rosa
R
Lombardi
2nd Department of Internal Medicine, Hippokration General Hospital, Athens, Greece.
Helen
H
Sambatakou
2nd Department of Internal Medicine, Hippokration General Hospital, Athens, Greece.
Ilias
I
Mariolis
Department of Radiology, Evangelismos General Hospital, Athens, Greece.
Demosthenis
D
Cokkinos
Academic Department of Gastroenterology, Laiko General Hospital, Athens, Greece.
George V
GV
Papatheodoridis
Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK. Electronic address: e.tsochatzis@ucl.ac.uk.
Emmanuel A
EA
Tsochatzis
D000328:Adult; D054459:Elasticity Imaging Techniques; D005260:Female; D006115:Greece; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D014463:Ultrasonography
APRI; Diagnostic accuracy; Elastography; FIB4; NAFLD; Non-invasive assessment