Prevalence and risk factors for significant liver fibrosis among HIV-monoinfected patients

Michelle Dallapiazza,Jay R Kostman,Russell Localio,Valerianna K Amorosa,Vincent Lo Re

doi:10.1186/1471-2334-10-116

Abstract

BackgroundHIV-monoinfected patients may be at risk for significant liver fibrosis, but its prevalence and determinants in these patients are unknown. Since HIV-monoinfected patients do not routinely undergo liver biopsy, we evaluated the prevalence and risk factors of significant hepatic fibrosis in this group using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI).MethodsWe conducted a cross-sectional study among HIV-infected patients negative for hepatitis B surface antigen and hepatitis C antibody in the Penn Center for AIDS Research Adult/Adolescent Database. Clinical and laboratory data were collected from the database at enrollment. Hypothesized determinants of significant fibrosis were modifiable risk factors associated with liver disease progression, hepatic fibrosis, or hepatotoxicity, including immune dysfunction (i.e., CD4 T lymphocyte count <200 cells/mm3, HIV viremia), diseases associated with hepatic steatosis (e.g., obesity, diabetes mellitus), and use of antiretroviral therapy. The primary outcome was an APRI score >1.5, which suggests significant hepatic fibrosis. Multivariable logistic regression identified independent risk factors for significant fibrosis by APRI.ResultsAmong 432 HIV-monoinfected patients enrolled in the CFAR Database between November 1999 and May 2008, significant fibrosis by APRI was identified in 36 (8.3%; 95% CI, 5.9 - 11.4%) patients. After controlling for all other hypothesized risk factors as well as active alcohol use and site, detectable HIV viremia (adjusted OR, 2.56; 95% CI, 1.02 - 8.87) and diabetes mellitus (adjusted OR, 3.15; 95% CI, 1.12 - 10.10) remained associated with significant fibrosis by APRI.ConclusionsSignificant fibrosis by APRI score was found in 8% of HIV-monoinfected patients. Detectable HIV viremia and diabetes mellitus were associated with significant fibrosis. Future studies should explore mechanisms for fibrosis in HIV-monoinfected patients.

Highlights

HIV-monoinfected patients may be at risk for significant liver fibrosis, but its prevalence and determinants in these patients are unknown
Since liver biopsy results are generally not available on sufficiently large numbers of HIVmonoinfected patients to permit appropriate epidemiologic analyses, we used a non-invasive measure of significant liver fibrosis, the aspartate aminotransferase (AST)to-platelet ratio index (APRI)
Our hypothesized determinants of significant fibrosis were modifiable risk factors associated with liver disease progression, hepatic fibrosis, or hepatotoxicity, including immune dysfunction (i.e., CD4 T lymphocyte count

Summary

Introduction

HIV-monoinfected patients may be at risk for significant liver fibrosis, but its prevalence and determinants in these patients are unknown. Since HIV-monoinfected patients do not routinely undergo liver biopsy, we evaluated the prevalence and risk factors of significant hepatic fibrosis in this group using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI). To address this issue, we evaluated the prevalence and risk factors for significant hepatic fibrosis among HIVmonoinfected patients. Since liver biopsy results are generally not available on sufficiently large numbers of HIVmonoinfected patients to permit appropriate epidemiologic analyses, we used a non-invasive measure of significant liver fibrosis, the aspartate aminotransferase (AST)to-platelet ratio index (APRI). This index has previously been validated as a surrogate marker of significant

Methods

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Conclusion