Traditional but Not HIV-Related Factors Are Associated with Nonalcoholic Fatty Liver Disease in Asian Patients with HIV-1 Infection

Takeshi Nishijima,Yoshimi Kikuchi,Yuichi Nozaki,Mikio Yanase,Shinichi Oka,Hiroyuki Gatanaga,Takuro Shimbo,Naoyoshi Nagata,Hirokazu Komatsu,Ming-Lung Yu

doi:10.1371/journal.pone.0087596

Takeshi Nishijima, Yoshimi Kikuchi + Show 8 more

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https://doi.org/10.1371/journal.pone.0087596

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Abstract

BackgroundThe prevalence and factors associated with nonalcoholic fatty liver disease (NAFLD) are largely unknown in HIV-1 monoinfected patients.MethodsThe present study elucidated the prevalence and factors associated with NAFLD among Asian patients with HIV-1 infection who underwent abdominal ultrasonography between January 2004 and March 2013. Diagnosis of NAFLD was based on the liver to kidney contrast and diffusion in hepatic echogenicity. Uni- and multi-variate logistic regression analyses were applied to estimate factors associated with NAFLD.Results435 Asian patients free of chronic hepatitis B or C virus infection and without excessive alcohol intake were analyzed. NAFLD was diagnosed in 135 (31%) patients. Obesity (BMI >30 kg/m2) was evident in 18 (4.1%) patients, and BMI was >25 kg/m2 in 103 (24%). Multivariate analysis identified higher BMI (per 1 kg/m2 increment, adjusted OR = 1.198; 95% CI, 1.112–1.290; p<0.001), dyslipidemia (adjusted OR = 2.045; 95% CI, 1.183–3.538; p = 0.010), and higher ALT to AST ratio (per 1 increment, adjusted OR = 3.557; 95% CI, 2.129–5.941; p<0.001) as significant factors associated with NAFLD. No HIV-specific variables, including treatment with dideoxynucleoside analogues (didanosine, stavudine, and zalcitabine) and cumulative duration of antiretroviral therapy (ART), were associated with NAFLD.ConclusionsThe incidence of NALFD among Asian patients with HIV-1 infection is similar to that in Western countries. NAFLD was associated with high BMI, dyslipidemia, and high ALT/AST ratio, but not with HIV-related factors. The results highlight the importance of early recognition and management of NAFLD and traditional factors associated with NAFLD for Asian patients with HIV-1 infection.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is characterized by the presence of fat infiltration in the liver in the absence of excessive alcohol consumption or other causes of liver disease, such as viral hepatitis, and is considered the most common cause of fatty liver [1]
Only two studies have previously examined the prevalence and associated factors with nonalcoholic fatty liver disease (NAFLD) in patients infected with HIV-1 only (those without chronic hepatitis C virus (HCV) infection) [8,9]
The use of so called ‘‘D drugs’’: dideoxynucleoside analogues [didanosine, stavudine (d4T), and zalcitabine], a subgroup of antiretroviral agents nucleoside reverse transcriptase inhibitors (NRTI), is reported to be associated with NAFLD, others have argued against such relation [8,9]

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is characterized by the presence of fat infiltration in the liver in the absence of excessive alcohol consumption or other causes of liver disease, such as viral hepatitis, and is considered the most common cause of fatty liver [1]. Only two studies (one from Italian metabolic clinic and the other from American naval hospital) have previously examined the prevalence and associated factors with NAFLD in patients infected with HIV-1 only (those without chronic hepatitis C virus (HCV) infection) [8,9]. At this stage, it is unknown whether variables specific to HIV-1 infection, such as HIV-1 viral load and cumulative years of antiretroviral therapy (ART) are associated with NAFLD. The prevalence and factors associated with nonalcoholic fatty liver disease (NAFLD) are largely unknown in HIV-1 monoinfected patients

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