1038 Outcomes of Non-Alcoholic Steatohepatitis in African American Patients With Human Immunodeficiency Virus (HIV)

Abstract

INTRODUCTION: Non-alcoholic steatohepatitis (NASH) is the hepatic manifestation of metabolic syndrome and is highly prevalent in patients with HIV, ranging from 13% to 55%. According to the center for disease control and prevention (CDC), in 2016 African Americans(AA) had the highest rate of HIV diagnosis (44%).Minorities are disproportionately affected by HIV and have a higher risk of developing NASH and progressive liver disease. Data on the outcomes of NASH in AA patients with HIV and the disease progression is scanty and poorly studied. METHODS: We retrieved data from the Nationwide Inpatient Sample (NIS) database for the year 2012.The study group consisted of AA patients between ages 18–75 years with NASH and HIV/AIDS (n = 138). Control group included subjects with NASH alone (n = 3681). Our outcomes of interest were: overall mortality, Ascites, Hepatocellular carcinoma (HCC), End stage liver disease (ESLD), Hepatic encephalopathy (HE), Liver cirrhosis and Portal hypertension. All clinical characteristics were defined as per the International Classification of Disease 9th revision (ICD-9) codes. Logistics regression analysis was used to estimate the adjusted odds ratio (aOR) of outcomes amongst participants with coexisting NASH/HIV while accounting for comorbidities and this was compared to those with NASH alone. RESULTS: The mean age sample was 49 ± 12 (61% female, 39% male). The rates of ascites were higher among those with NASH/HIV compared to NASH alone (10.1% vs 4.6%, P < 0.005). After adjusting for comorbidities, the aOR for hepatic encephalopathy 1.232 (0.379-4.009), ascites 1.753 (0.962-3.196) and portal hypertension 2.258 (0.276-18.465) was higher in NASH/HIV group compared to NASH alone. Stratified analysis based on age and sex revealed that females with NASH/HIV have a statistically significant higher odd for ascites; age 18-45, aoR 4.752 (2.155-10.478) and portal hypertension age 46- 75 aoR 19.832 (1.182 - 332.644) compared with NASH alone. CONCLUSION: African American female patients with NASH coexisting with HIV were at a higher risk for portal hypertension and ascites when compared to those with NASH alone. Further studies will look to evaluate and mitigate the impact of HIV on NASH in this patient population.