Abstract
BackgroundLiver disease is a leading cause of morbidity and mortality among Human Immunodeficiency virus (HIV) infected patients; however no consensus exists on HIV-related risk factors for it. The aim of this study was to identify risk factors for liver fibrosis/cirrhosis in a cohort of Greek HIV-infected patients.MethodsPatients attending the HIV outpatient clinic of Pathophysiology Department at «Laiko» General Hospital in Athens, Greece, between December 2014 and December 2017 were eligible for inclusion. Inclusion criteria were confirmed HIV infection and age > 18 years. Exclusion criteria were Body-Mass index (BMI) > 40, liver metastases of malignant diseases and concurrent or previous chemotherapy.Liver stiffness (LS) was measured using Vibration Controlled Transient Elastography (TE) and laboratory tests were acquired in all patients. Patients were classified in 2 groups: those with mild or no fibrosis (equivalent to Metavir score F0-F2) and those with significant fibrosis (equivalent to Metavir score F3-F4).ResultsA total of 187 consecutive patients were included in this study. Median TE value was 5.1 kilopascals (KPa) (range 2.8–26.3), with 92.5% (173/187) of the patients having no/mild fibrosis and 7.4% (14/187) significant fibrosis.On multivariate logistic regression analysis older patient’s age, abnormal serum aspartate aminotransferase (AST) value, Hepatitis C virus (HCV) infection, alcohol abuse, CD4/CD8 ratio and an increased number of liver related events (LREs) were significantly correlated with liver fibrosis/cirrhosis.ConclusionsIn our cohort of HIV-infected individuals HCV/HIV co-infection, older age, alcohol abuse and CD4/CD8 ratio seem to correlate with fibrogenesis in the liver.
Highlights
Liver disease is a leading cause of morbidity and mortality among Human Immunodeficiency virus (HIV) infected patients; no consensus exists on HIV-related risk factors for it
As liver related event (LRE) was defined every event associated with the liver like transaminasemia, acute viral hepatitis, portal vein thrombosis and drug-induced liver injury, with transaminasemia being defined as the existence of serum transaminases levels > 3 x upper limit of normal (ULN), according to reference laboratory values, and hyperbilirubinemia as total serum bilirubin levels > 2 x ULN
This study included a total of 187 HIV-infected patients; 170 (90.9%) were male with 135 (79.4%) of them being men who have sex with men (MSM)
Summary
Liver disease is a leading cause of morbidity and mortality among Human Immunodeficiency virus (HIV) infected patients; no consensus exists on HIV-related risk factors for it. The aim of this study was to identify risk factors for liver fibrosis/cirrhosis in a cohort of Greek HIV-infected patients. Human immunodeficiency virus (HIV) infection constitutes a major global public health issue, with 37 million people worldwide, 34 of them being adults, being infected from HIV [1]. Liver conditions complicating HIV infection have changed during the years. Starting from the early AIDSperiod, when the major problem was hepatitis B with or without hepatitis D infection, moving to the 2000s with the rise of hepatitis C virus (HCV) infection and nowadays with the alcoholic and non-alcoholic fatty liver. Androutsakos et al BMC Gastroenterology (2020) 20:91 disease, liver involvement has been a major issue in the history of HIV infection [9]. Among them transient elastography (TE) seems to provide the most reliable results with high creditability, being superior to serum biomarkers which sometimes underestimate the magnitude of liver disease [14,15,16,17,18]
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