Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.ObjectivesThe aim of this study was to explore visceral fat thickness (VFT) and anthropometric measurements associated with the development of NAFLD in patients mono-infected with HIV and on long-standing combination antiretroviral therapy (cART).MethodEighty-eight (n = 88) HIV-positive male patients, average age 39.94 ± 9.91 years, and stable on cART, were included in this prospective study. VFT was measured using ultrasonography. Anthropometric measurements included body mass index (BMI), waist-to-hip ratio (W/H), waist-to-height ratio (WHtR), waist and hip circumference (WC, HC). Differences between variables were determined using the chi-square test. The receiver operating characteristic (ROC) curve and the Youden index were used to determine optimal cut-off values of VFT and hepatic steatosis. The area under the curve (AUC), 95% confidence intervals, sensitivity and specificity are reported for the complete sample. Significance was set at p < 0.05.ResultsPatients with steatosis had significantly higher values of BMI, HC, WC, W/H and WHtR. The VFT was higher in patients with steatosis (p < 0.001). Specifically, VFT values above 31.98 mm and age > 38.5 years correlated with steatosis in HIV-positive patients, namely sensitivity 89%, specificity 72%, AUC 0.84 (95% CI, 0.76–0.93, p < 0.001), with the highest Youden index = 0.61. The sensitivity of the age determinant above this cut-off point was 84%, specificity 73% and AUC 0.83 (95% CI, 0.75–0.92, p < 0.001), with the highest Youden index of 0.57.ConclusionIn the absence of more advanced radiographic and histological tools, simple anthropometric measurements and VFT could assist in the early identification of persons at risk of hepatic steatosis in low- and middle-income regions.
Highlights
Non-alcoholic fatty liver disease (NAFLD) represents the most common chronic liver condition of developed countries.[1]
The visceral fat thickness (VFT) was significantly higher in patients with steatosis (p < 0.001)
The peripheral depot has a protective role in cardiovascular diseases development, excessive caloric intake over time overwhelms this depot and fat is transferred to the central compartment, leading to central obesity (CO), a fundamental component of the cardiometabolic syndrome (CMS).[21]
Summary
Non-alcoholic fatty liver disease (NAFLD) represents the most common chronic liver condition of developed countries.[1]. Prevalence rates are even higher among type 2 diabetics (55%) and the obese (75%).[3] In the past, this condition was thought to be of little clinical importance.[4] it is known that many (20%) will develop non-alcoholic steatohepatitis (NASH) and that one in four of the latter will develop cirrhosis.[5]. Non-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma
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