Abstract
Background/objectives: Psoriasis is the most frequent skin disease in HIV-infected patients. Nonalcohol fatty liver disease (NAFLD) is more prevalent in patients with psoriasis. We report the prevalence of psoriasis and NAFLD and investigate risk factors of liver damage in HIV-infected patients with psoriasis. Methods: We performed a retrospective observational study. Steatosis was defined as indicative abdominal ultrasound findings, CAP (controlled attenuated parameter by transient elastography) > 238 dB/m, and/or triglyceride and glucose index (TyG) > 8.38. Significant (fibrosis ≥ 2) and advanced liver fibrosis (fibrosis ≤ F3) were studied by transient elastography (TE) and/or FIB-4 using standard cutoff points. FIB-4 (Fibrosis 4 score) results were adjusted for hepatitis C (HCV)-coinfected patients. Results: We identified 80 patients with psoriasis (prevalence, 1.5%; 95% CI, 1.1–1.8). Psoriasis was severe (PASI > 10 and/or psoriatic arthritis) in 27.5% of cases. The prevalence of steatosis was 72.5% (95% CI, 65–85). Severe psoriasis was an independent risk factor for steatosis (OR, 12; 95% CI, 1.2–120; p = 0.03). Significant liver fibrosis (p < 0.05) was associated with HCV coinfection (OR 3.4; 95% CI, 1.1–10.6), total CD4 (OR 0.99; 95% CI, 0.99–1), and time of efavirenz exposure (OR 1.2; 95% CI, 1.0–1.3). Conclusions: The prevalence of psoriasis in HIV-infected patients was similar to that of the general population. Steatosis is highly prevalent, and severe psoriasis is an independent risk factor for steatosis in HIV-infected patients.
Highlights
Severe psoriasis and metabolic syndrome were independent associated factors of steatosis. This finding agrees with data from the meta-analysis by Candia et al, which included more than 50,000 patients and reported a higher risk of Nonalcohol fatty liver disease (NAFLD) in patients with severe psoriasis than in those with less severe forms, albeit with an OR of 2.07, which is much lower than the value we report in the present study, probably due to the smaller number of subjects included in our cohort [12]
We found no association with metabolic factors, in contrast with the general population, where a previous history of metabolic syndrome was associated with the presence of liver fibrosis [15]
The prevalence of psoriasis in our cohort of patients with well-controlled chronic human immunodeficiency virus (HIV) infection was similar to that found in the general population
Summary
Non-HIV-associated comorbid conditions, such as cardiovascular events and non-AIDSdefining malignant tumors, are becoming increasingly frequent [1]. This phenomenon is due to the increase in survival; HIV-infected persons maintain marked long-term immunological activation, despite the fact that their disease is controlled with ART [2]. Psoriasis is a chronic inflammatory disease that affects 1–4% of the world’s population (estimated at 2.3% in Spain) [2] It can be a form of presentation of HIV infection, its symptoms are very varied and atypical, it is usually severe, and its prevalence is similar to that recorded in the general population [3]. It was recently reported that HIV infection is an independent risk factor for developing psoriasis [4]
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