Abstract
Background and aimHIV-infected individuals are at high risk of developing nonalcoholic steatohepatitis (NASH), a leading cause of end-stage liver disease in Western countries. Nonetheless, due to the invasiveness of liver biopsy, NASH remains poorly understood in HIV mono-infection. We aimed to characterize the prevalence and predictors of NASH in unselected HIV mono-infected patients by means of non-invasive diagnostic tools.MethodsHIV-infected adults without significant alcohol intake or co-infection with hepatitis B or C underwent a routine screening program employing transient elastography (TE) with controlled attenuation parameter (CAP) and the serum biomarker cytokeratin-18 (CK-18). NASH was diagnosed non-invasively as the coexistence of fatty liver (CAP ≥248 dB/m) and CK-18 >246 U/L. Identified cases of NASH were offered a diagnostic liver biopsy. Predictors of NASH were determined by multivariate logistic regression analysis.Results202 consecutive HIV mono-infected patients were included. NASH was non-invasively diagnosed in 23 cases (11.4%). Among them, 17 underwent a liver biopsy, and histology confirmed NASH in all cases. The prevalence of NASH was higher in patients with hypertriglyceridemia (17.1%), insulin resistance defined by homeostasis model for assessment of insulin resistance (HOMA-IR) (25%), those with detectable HIV viral load (42.9%) and those with elevated ALT (53.6%). After adjustment, higher HOMA-IR (adjusted odds ratio [aOR] = 1.20, 95% CI 1.01–1.43; p = 0.03) and ALT (aOR = 2.39, 95% CI 1.50–3.79; p<0.001) were independent predictors of NASH.ConclusionsNASH, diagnosed by a non-invasive diagnostic approach employing CK-18 and TE with CAP, is common in unselected HIV mono-infected individuals, particularly in the presence of insulin resistance and elevated ALT.
Highlights
Liver disease is the leading cause of non-AIDS related deaths in people living with human immunodeficiency virus (HIV)[1]
The prevalence of nonalcoholic steatohepatitis (NASH) was higher in patients with hypertriglyceridemia (17.1%), insulin resistance defined by homeostasis model for assessment of insulin resistance (HOMA-IR) (25%), those with detectable HIV viral load (42.9%) and those with elevated ALT (53.6%)
Higher HOMA-IR and ALT were independent predictors of NASH
Summary
Liver disease is the leading cause of non-AIDS related deaths in people living with human immunodeficiency virus (HIV)[1] This excess morbidity is mainly driven by coinfections with hepatitis B or C virus, nonalcoholic fatty liver disease (NAFLD) is increasingly being recognized as a common cause of liver fibrosis in HIV mono-infected patients receiving antiretroviral therapy (ART). Simple NAFLD is the first pathophysiological step leading to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and damage in response to accumulated fat within the liver parenchyma. This process can lead to cirrhosis, hepatocellular carcinoma (HCC) and liver failure[6].
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