Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection.

Barbara Rossetti,Raffaele Bruno,Massimiliano Fabbiani,Maria Cristina Moioli,Giacomo Zanelli,Massimo Puoti,Valentina Borgo,Davide Motta,Laura Maiocchi,Miriana D’Alessandro,Arianna Emiliozzi,Margherita Sambo,Marta Colaneri,Teresa Chiara Pieri,Pietro Valsecchi,Chiara Baiguera,Francesca Montagnani

doi:10.3390/diagnostics12010014

Abstract

Severe liver fibrosis (LF) is associated with poor long-term liver-related outcomes in people living with HIV (PLWH). The study aimed to explore the prevalence and predictors of LF and the concordance between different non-invasive methods for the estimation of LF in HIV-infected individuals without hepatitis virus infection. We enrolled PLWH with HIV-1-RNA <50 copies/mL for >12 months, excluding individuals with viral hepatitis. LF was assessed by transient elastography (TE) (significant >6.65 kPa), fibrosis-4 (FIB-4) (significant >2.67), and AST-to-platelet ratio index (APRI) (significant >1.5). We included 234 individuals (67% males, median age 49 years, median time from HIV diagnosis 11 years, 38% treated with integrase strand transfer inhibitors). In terms of the TE, 13% had ≥F2 stage; FIB-4 score was >1.5 in 7%; and APRI > 0.5 in 4%. Higher body mass index, diabetes mellitus, detectable baseline HIV-1 RNA and longer atazanavir exposure were associated with higher liver stiffness as per TE. Predictors of higher APRI score were CDC C stage and longer exposure to tenofovir alafenamide, while HBcAb positivity and longer exposure to tenofovir alafenamide were associated to higher FIB-4 scores. Qualitative agreement was poor between FIB-4/TE and between APRI/TE by non-parametric Spearman correlation and kappa statistic. In our study, in the group of PLWH without viral hepatitis, different non-invasive methods were discordant in predicting liver fibrosis.

Highlights

Licensee MDPI, Basel, Switzerland.Human immunodeficiency virus (HIV) infection is one of the most serious public health challenges, affecting approximately 37.6 million people across the globe in 2020, of whom 34 million are adults [1]
Severe liver fibrosis is associated with poor long-term liver-related outcomes and mortality, and people living with HIV (PLWH) are at higher risk of multifactorial liver injuries than people without
At multivariate linear regression analysis, after adjustment for potential confounders, we found association between higher FIB-4 scores and HbcAb positivity and longer cumulative exposure to tenofovir alafenamide (TAF)

Summary

Introduction

Human immunodeficiency virus (HIV) infection is one of the most serious public health challenges, affecting approximately 37.6 million people across the globe in 2020, of whom 34 million are adults [1]. Severe liver fibrosis is associated with poor long-term liver-related outcomes and mortality, and PLWH are at higher risk of multifactorial liver injuries than people without HIV [12,13,14,15,16,17,18]. Several studies have confirmed the possible causes contributing to the progression of liver fibrosis in PLWH, in particular, age, coinfections with viral hepatitis and alcohol abuse [19,20,21,22,23,24]. The potential effect of body mass index and the presence of hypertriglyceridemia or diabetes mellitus are debated and inconclusive [22,25]

Methods

Discussion

Conclusion