Relationships between hepatic steatosis and frailty differ by HIV serostatus

Abstract

Background: Frailty is associated with obesity-related comorbidities, but the relationship with non-alcoholic fatty liver disease (NAFLD) in people with HIV (PWH) has been incompletely described. Our objective was to assess the associations between NAFLD and frailty. Methods: Cross-sectional and longitudinal analysis of men in the Multicenter AIDS Cohort Study (MACS). NAFLD was defined as a liver/spleen ratio < 1.0 on abdominal CT scans; frailty was defined by the frailty phenotype as having 3 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Results: Men without (n=200) and with HIV (n=292) were included. NAFLD prevalence was 21% in men without vs 16% in men with HIV; frailty 12% vs 17%. Among men with NAFLD, frailty was more prevalent in men without HIV (21% vs 11%). In multivariate analysis, NAFLD was significantly associated with frailty after controlling for significant variables. Men without HIV and NAFLD had 2.6 times higher probability [95% CI: 1.2-5.7] of frailty relative to men without NAFLD. This association was not seen in men with HIV. The probability of frailty was higher among men without HIV with NAFLD vs without NAFLD (27% vs 11%) but lower among men with HIV with NAFLD vs without NAFLD (14% vs 19%). No significant relationships were found in longitudinal analyses. Conclusions: NAFLD was independently associated with frailty among men without HIV but not men with HIV, despite increased prevalence of frailty among men with HIV. The mechanisms of the muscle-liver-adipose tissue axis underlying NAFLD might differ by HIV serostatus.