S1273 Prevalence of NAFLD and Fibrosis in Unselected Patients With HIV Monoinfection: A Systematic Review and Meta-Analysis

Abstract

Introduction: Liver disease remains a leading cause of morbidity and mortality among patient with HIV infection. Nonalcoholic fatty liver disease (NAFLD) is an emerging concern for patients living with HIV. The aim of this review is to examine the current literature and provide an accurate estimate of the prevalence of NAFLD and fibrosis in patients with HIV monoinfection. Methods: This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). We performed a systematic search of Pubmed and Embase databases to identify studies reporting the prevalence of NAFLD and/or fibrosis in patients with HIV monoinfection. To be considered eligible for inclusion studies should met the following criteria: 1) exclude patients who had concurrent HCV or HBV infection, 2) exclude patients with heavy alcohol use (as defined by each study), 3) HIV patients must be unselected, 4) diagnosis of steatosis and fibrosis should be based on imaging and criteria should be reported. Our primary outcome of interest was the prevalence of NAFLD and fibrosis in unselected HIV monoinfected patients. To estimate the pooled prevalence of NAFLD and fibrosis we performed a random effects meta-analysis. Results: Our systematic search yielded 3078 studies of which 122 were eligible for full text review. A total of 20 studies met our eligibility criteria and were included in the meta-analysis (Table). The overall pooled prevalence of NAFLD among HIV monoinfected patients was 34.2% (95% CI: 29.7%-38.9%), but significantly varied based on the diagnostic method used (Figure). The prevalence of moderate to severe hepatic steatosis was 15.5% (95% CI: 8.9-23.5%). The overall pooled prevalence of fibrosis (defined as liver stiffness measurement >/ 7.1 kPa on transient elastography) was 12.3% (95% CI: 10.1%-14.7%). Conclusion: Our study presents the most uptodate information on the prevalence of NAFLD and fibrosis in patients with HIV monoinfection. Our results show that the prevalence of NAFLD and fibrosis remain concerningly high among HIV monoinfected individuals. Several factors, including traditional NAFLD risk factors and HIV related factors, such as lipodystrophy and antiretroviral therapy, are probably contributing to these findings. Future studies should better characterize these factors, while screening for NAFLD and fibrosis should be considered in HIV monoinfected individuals. Table 1. - Studies characteristics Study Published Study Period Country Study Type Population Patients Diagnostic Method Almeida et al. 2021 2015-2019 Brazil Cross Sectional Adult 412 TE with CAP Pezzini et al. 2020 2016-2017 Brazil Cross Sectional Adult 98 TE with CAP Cervo et al. 2020 2013-2018 Canada-Italy Cross Sectional Adult 1511 TE with CAP Liu et al. 2020 2019-2020 China Cross Sectional Adult 361 TE with CAP Kirkegaard-Klitbo et al. 2020 2015-2016 Denmark Longitudinal Prospective Observational Adult 453 CT Lallukka-Brück et al. 2020 2019 Finland Longitudinal Prospective Observational Adult 41 H-MRS Lemoine et al. 2017 2011-2012 France Cross Sectional Adult 405 TE with CAP Bischoff et al. 2021 2013-2018 Germany Longitudinal Prospective Observational Adult 301 TE with CAP Lui et al. 2016 Not Reported Hong Kong Cross Sectional Adult 80 H-MRS Guaraldi et al. 2011 2007-2008 Italy Cross Sectional Adult 103 U/S Guaraldi et al. 2008 2006-2007 Italy Cross Sectional Adult 225 CT Milic et al. 2020 2018-2019 Italy Cross Sectional Adult 707 TE with CAP Nishijima et al. 2014 2004-2013 Japan Cross Sectional >17 435 U/S Vujanovic et al. 2019 2016-2018 Serbia Cross Sectional 22-50 88 U/S Jongraksak et al. 2021 2017-2018 Thailand Cross Sectional Adult 150 TE with CAP Aepfelbacher et al. 2019 2016-2018 USA Cross Sectional Adult 46 TE with CAP Crum-Cianflone et al. 2009 2006-2007 USA Cross Sectional Adult 216 U/S Price et al. 2019 2010-2013 USA Cross Sectional 40-70 340 CT Sim et al. 2021 Not Reported USA Cross Sectional 18-60 125 CT Lombardi et al. 2016 2015-2016 Greece Cross Sectional Adult 125 U/S Abbreviations: TE with CAP: Transient elastography with controlled attenuation parameter, CT: Computed Tomography, U/S: Ultrasound, H-MRS: Proton Magnetic Resonance Spectroscopy. Figure 1.: Prevalence of any grade hepatic steatosis.