Adriana Cervo1,2, Jovana Milic3,4, Giovanni Mazzola2, Filippo Schepis5, Salvatore Petta6, Thomas Krahn1, Bertrand Lebouche1,7, Marc Deschenes8, Antonio Cascio2, Giovanni Guaraldi3, Giada Sebastiani1,8. 1. Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada. 2. Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy. 3. Infectious Diseases Clinic, University of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy. 4. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. 5. Hepatology Unit, University of Modena and Reggio Emilia, Modena, Italy. 6. Gastroenterology and Hepatology Service, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy. 7. Department of Family Medicine, McGill University, Montreal, Canada. 8. Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.
Abstract
BACKGROUND: The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV. METHODS: We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients. RESULTS: We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04-1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11-1.63), and high ALT (aOR, 1.15; 95% CI, 1.05-1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26-.77). CONCLUSIONS: NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.
BACKGROUND: The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV. METHODS: We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients. RESULTS: We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04-1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11-1.63), and high ALT (aOR, 1.15; 95% CI, 1.05-1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26-.77). CONCLUSIONS: NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.
Authors: Javier Martínez-Sanz; María Visitación Calvo; Sergio Serrano-Villar; María Luisa Montes; Rosa Martín-Mateos; Diego Burgos-Santamaría; Jorge Díaz-Álvarez; Alba Talavera-Rodríguez; Marta Rosas; Santiago Moreno; Javier Fontecha; Matilde Sánchez-Conde Journal: J Clin Med Date: 2022-07-02 Impact factor: 4.964
Authors: Jennifer Price; Yifei Ma; Adaora Adimora; Margaret Fischl; Audrey L French; Elizabeth T Golub; Deborah Konkle-Parker; Mark H Kuniholm; Ighovwerha Ofotokun; Michael Plankey; Anjali Sharma; Phyllis C Tien Journal: BMJ Open Date: 2022-04-07 Impact factor: 2.692