Microbial translocation is associated with advanced liver fibrosis among people with HIV.

Abstract

The prevalence of liver complications is increasing among people living with HIV, and microbial translocation (MT) might play a vital role. We conducted a prospective cohort study to evaluate the association between plasma biomarkers of MT and liver fibrosis (LF) among people living with HIV in southwest China. A total of 665 people living with HIV were enrolled at baseline and had at least one follow-up visit during the 3-year study period. We calculated the Liver Fibrosis Index (FIB-4) to evaluate LF and measured plasma soluble CD14 (sCD14) and lipopolysaccharide-binding protein (LBP) as surrogate biomarkers for MT. We used ordinal logistic regression to investigate correlates of LF at baseline and used a linear mixed model to examine the association between dynamic changes in MT biomarkers and LF. Of the participants, 61 (9.17%) had advanced LF (FIB-4>3.25), and 193 (29.02%) had moderate LF (1.45 ≤ FIB-4 ≤ 3.25). Patients with advanced LF had higher plasma levels of sCD14 and LBP than those with moderate or no LF, both at baseline and at follow-up. The following factors were significantly associated with advanced LF: the highest quartile of LBP (adjusted odds ratio [aOR]=1.69; 95% confidence interval [CI] 1.02~2.81), current intravenous drug use (aOR=1.82; 95% CI 1.06~3.12), baseline CD4 <200 cells/μl (aOR=3.25; 95% CI 2.13~4.95), hepatitis C virus coinfection (aOR=2.52; 95% CI 1.41~4.51) and age >50years (aOR=32.66; 95% CI 15.89~66.36). LF progression (increasing FIB-4) was significantly associated with increasing sCD14level (β=1.11; 95% CI 0.97~1.26; p<0.001) with covariate adjustment. The significant relationship between MT and LF may reveal pathogenic mechanisms and potential intervention targets of liver complications among people living with HIV in China.