Abstract
Liver disease is an important cause of morbidity and mortality in people living with human immunodeficiency virus (PLWH), of which nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized cause. There are limited data investigating NAFLD in HIV monoinfection and histologically defined disease. We aimed to identify who is at risk of fibrosis, NAFLD, and nonalcoholic steatohepatitis (NASH) among PLWH and explore the diagnostic accuracy of noninvasive markers of fibrosis. This was a retrospective, cross-sectional, international, multicenter study including patients with HIV monoinfection, without chronic viral hepatitis or other known causes of chronic liver disease, who underwent liver biopsy for abnormal liver biochemistry and/or clinical suspicion of liver fibrosis. A total of 116 patients from 5 centers were included. Sixty-three (54%) had NAFLD, of whom 57 (92%) had NASH. Overall, 36 (31%) had advanced fibrosis (≥F3) and 3 (3%) had cirrhosis. Of the 53 cases without NAFLD, 15 (28%) had advanced fibrosis. Collagen proportionate area was similar between cases with and without NAFLD (3% vs 2%). Body mass index was independently associated with NAFLD (aOR, 1.2; 95% CI, 1.08-1.34), and type 2 diabetes was independently associated with advanced fibrosis (aOR, 3.42; 95% CI, 1.00-11.71). The area under the curve for advanced fibrosis was 0.65 and 0.66 for both NAFLD Fibrosis Score (NFS) and FIB-4. Cutoff values of -1.455 (NFS) and 1.3 (FIB-4) have negative-predictive values of 0.80 and 0.82, respectively. Advanced fibrosis is strongly associated with type 2 diabetes in PLWH. Serological markers require further optimization.
Highlights
It encompasses a large spectrum of disease from non-alcoholic fatty liver (NAFL, “simple steatosis”) to hepatocyte inflammation/ballooning defined as non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis
This study reports the largest known sample of liver biopsies in HIV mono-infection, read by t a central expert liver pathologist, in which the primary risk factor identified for non-alcoholic fatty liver disease (NAFLD) was ip BMI and for advanced fibrosis was type 2 diabetes. cr NAFLD is common in people living with HIV (PLWH), but understanding more clearly which patients progress to s NASH and advanced fibrosis will help clinicians to appropriately risk stratify patients for u further investigation such as a liver biopsy and initiate appropriate management. an In this study, subjects were selected from five centres in Europe and North America who had had a liver biopsy without other cause of chronic liver disease
Of the 63 subjects with NAFLD, 57 (90%) had te NASH, and 58% of the whole cohort had ≥F2 fibrosis, reflecting the selection criteria in p centres to biopsy patients with a high pre-test probability of more advanced disease. e Collagen proportionate area (CPA) was used as a quantitative measure of fibrosis, which showed that the quantity of c collagen deposition is similar between stages F0-F2 but increases steeply from F3-F4
Summary
It encompasses a large spectrum of disease from non-alcoholic fatty liver (NAFL, “simple steatosis”) to hepatocyte inflammation/ballooning defined as non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis. The primary objective was to assess the histopathological features of liver biopsies e performed in HIV mono-infection and identify risk factors associated with fibrosis, NAFLD c and NASH. The secondary objective was to assess the performance of non-invasive tests Ac for the diagnosis of liver fibrosis in patients with HIV mono-infection using liver histology as a reference standard. We aimed to identify who is at risk of fibrosis, NAFLD and NASH among PLWH, and explore the diagnostic accuracy of non-invasive markers of fibrosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
