Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people

Tamar Taddei,Joseph K Lim,Adeel A Butt,Matthew J Budoff,Maria C Rodriguez-Barradas,Matthew B Goetz,Matthew S Freiberg,Jessie Torgersen,Jay R Kostman,Amy C Justice,Vincent Lo Re,Kaku So-Armah

doi:10.1186/s12876-019-0969-1

Abstract

BackgroundHepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection. We compared the prevalence and severity of hepatic steatosis between HIV-infected (HIV+) and uninfected persons and identified factors associated with greater steatosis severity within both groups.MethodsWe performed a cross-sectional study among participants without cardiovascular disease who participated in a substudy of the Veterans Aging Cohort Study. Hepatic steatosis was defined by noncontrast computed tomography (CT) liver-to-spleen (L/S) attenuation ratio < 1.0. Multivariable linear regression was used to: 1) evaluate the association between HIV infection and severity of hepatic steatosis, as measured by absolute liver attenuation, and 2) identify factors associated with greater severity of steatosis, by HIV status.ResultsAmong 268 participants (median age, 55 years; 99% male; 79% black; 23% obese; 64% HIV+ [91% on antiretroviral therapy]), the overall prevalence of steatosis was 7.8% and was similar between HIV+ and uninfected individuals (13 [7.6%] versus 8 [8.2%], respectively; p = 0.85). Participants with HIV, the majority of whom received antiretroviral therapy, had a higher mean absolute liver attenuation (mean difference, 5.68 Hounsfield units; p < 0.001), correlating with lesser hepatic steatosis severity, compared to uninfected participants. After adjusting for covariates, only advanced hepatic fibrosis was associated with greater severity of steatosis in HIV+ persons (p = 0.03) and uninfected individuals (p < 0.001).ConclusionsIn this sample of participants without cardiovascular disease, the prevalence of hepatic steatosis by noncontrast abdominal CT was not different by HIV status. Increasing severity of steatosis was independently associated with advanced hepatic fibrosis in both groups.

Highlights

Hepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection
The prevalence of hepatic steatosis (L/S < 1.0) was similar between HIV+ and uninfected participants (13 [7.6%; 95% confidence intervals (CI), 3.6–11.6%] versus 8 [8.2%; 95% CI, 2.7– 13.6%]; p = 0.85)
In multivariable linear regression models stratified by HIV status, advanced hepatic fibrosis/cirrhosis by FIB-4 remained the only factor associated with greater severity of steatosis among HIV+ and uninfected individuals, such that for FIB-4 > 3.25, the severity of steatosis was increased by − 6.07 Hounsfield Units (HU) and − 18.22 HU, respectively

Summary

Introduction

Hepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection. We compared the prevalence and severity of hepatic steatosis between HIV-infected (HIV+) and uninfected persons and identified factors associated with greater steatosis severity within both groups. Liver disease is a leading cause of morbidity and mortality in HIV-infected (HIV+) individuals [1, 2]. Chronic viral hepatitis accounts for the majority of this disease burden, but hepatic steatosis has emerged as a potential contributor to liver fibrosis progression in this population [3, 4]. We compared the prevalence and severity of hepatic steatosis, as determined by noncontrast abdominal computed tomography (CT), between HIV+ and uninfected persons within a subcohort of the Veterans Aging Cohort Study (VACS) and evaluated risk factors for greater severity of steatosis within both groups

Methods

Results

Discussion

Conclusion