Liver fibrosis and fatty liver in Asian HIV‐infected patients

• Published in: Alimentary pharmacology & therapeutics Vol. 44; no. 4; pp. 411 - 421
• Main Authors: Lui, G., Wong, V. W.‐S., Wong, G. L.‐H., Chu, W. C.‐W., Wong, C.‐K., Yung, I. M. H., Wong, R. Y. K., Yeung, S.‐L., Yeung, D. K.‐W., Cheung, C. S. K., Chan, H.‐Y., Chan, H. L.‐Y., Lee, N.
• Format: Journal Article
• Language: English
• Published: England 01.08.2016
• Subjects: Adult; Aged; Asian Continental Ancestry Group; Biomarkers - blood; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - etiology; Case-Control Studies; Elasticity Imaging Techniques; Fatty Liver - blood; Fatty Liver - diagnostic imaging; Fatty Liver - etiology; Female; HIV Infections - blood; HIV Infections - complications; HIV Infections - diagnostic imaging; Hong Kong - epidemiology; Humans; Keratin-18 - blood; Liver Cirrhosis - blood; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - etiology; Liver Neoplasms - blood; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - etiology; Magnetic Resonance Spectroscopy; Male; Middle Aged; Prevalence; Risk Factors
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13702

Summary Background Little is known about the importance of liver fibrosis and fatty liver in HIV‐monoinfected individuals without hepatitis virus co‐infection, particularly among the Asian population. Aim To evaluate prevalence and risk factors for liver fibrosis and fatty liver in Asian HIV‐monoinfected individuals. Methods Eighty asymptomatic HIV‐monoinfected individuals (tested negative for HBV/HCV) were compared with 160 matched HIV‐uninfected healthy controls. Transient elastography and proton‐magnetic resonance spectroscopy (1H‐MRS) were performed to measure liver stiffness and hepatic steatosis respectively. Blood samples were analysed for metabolic profiles and markers of steatohepatitis (e.g. cytokeratin‐18). Results All HIV‐infected individuals (mean ± s.d. age 54 ± 11 years, male 93%, Chinese 94%; diagnosis median duration 8 (IQR 4–13 years) were stable on anti‐retrovirals (PI‐based 58.7%, NNRTI‐based 25.0% integrase‐inhibitors 16.3%); diabetes, dyslipidaemia, and metabolic syndrome were common. Fatty liver disease was detected in 28.7%. There was significantly higher degree of liver stiffness [4.9 (IQR 4.1–6.2) kPa vs. 4.2 (IQR 3.6–5.0) kPa, P < 0.001], and greater proportions developed significant fibrosis (7.0 kPa, 14.3% vs. 3.1%, P = 0.001) and cirrhosis (10.3 kPa, 5.2% vs. 0.6%, P = 0.040) compared with controls. HIV infection was an independent risk factor for significant fibrosis (adjusted OR 4.00, 95% CI 1.29–12.41, P = 0.016). HIV‐infected individuals with fatty liver had excessive liver stiffness and fibrosis. Two cases of asymptomatic hepatocellular carcinoma were detected. Conclusions HIV‐monoinfected patients are at risk for liver fibrosis and cirrhosis. HIV‐related mechanisms and fatty liver disease may play important roles. Screening and intervention to prevent severe outcomes should be considered.