NAFLD and Advanced Fibrosis Are Common in Adults with HIV

Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by the accumulation of fat in the liver of individuals who do not consume excessive alcohol. In people living with HIV, NAFLD is a common comorbidity, with prevalence rates ranging from 14.6 to 75 percent. The relationship between NAFLD and HIV is multifactorial, involving factors such as metabolic syndrome, hyperuricemia, and the impact of antiretroviral therapy (ART) on metabolic health.

Despite advancements in HIV treatment, NAFLD remains a significant concern, with poorly understood risk factors specific to this population.

To address this gap, a session at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) focused on an ongoing prospective study that’s screened persons with HIV (PWH) aged 18 and above who were on suppressive antiretroviral therapy (ART) for NAFLD and advanced fibrosis (AF) using vibration-controlled transient elastography.

The study included 654 participants with a mean age of 53 years, predominantly male (73 percent), and racially diverse as 51 percent of participants were non-Hispanic Black and 20 percent were Hispanic. The prevalence of NAFLD was found to be alarmingly high at 53 percent, with 6 percent exhibiting advanced fibrosis. Traditional metabolic risk factors such as older age, male sex, higher body mass index, waist circumference, elevated alanine aminotransferase, and triglyceride concentrations were associated with increased odds of NAFLD. Interestingly, non-Hispanic Black participants had lower odds of NAFLD.

Similarly, factors like higher BMI or waist circumference, elevated aspartate aminotransferase and alkaline phosphatase concentrations, and lower platelet counts were associated with increased odds of AF, with non-Hispanic Black participants again showing lower odds. However, HIV-/ART-specific characteristics did not significantly influence the risk of NAFLD or AF in this cohort.

Histological analysis of liver biopsies revealed notable differences between NAFLD in PWH and those without HIV. NAFLD-PWH exhibited less steatosis, inflammation, hepatocyte ballooning, and portal inflammation compared to controls. Consequently, the NAFLD Activity Score (NAS) was lower in NAFLD-PWH, indicating less severe steatohepatitis. But despite these differences, NAFLD-PWH showed more fibrosis, suggesting HIV-specific factors beyond traditional histological drivers may contribute to fibrosis progression.

In conclusion, the study highlights the high prevalence of NAFLD among PWH and identifies traditional metabolic risk factors as primary drivers. Despite milder histological features, PWH with NAFLD exhibited higher fibrosis stages, indicating potential HIV-specific factors influencing disease progression. This underscores the importance of systematic screening and tailored management strategies for NAFLD among PWH. And while traditional metabolic risk factors play a significant role, there’s a need to explore HIV-specific factors contributing to liver disease progression.

Lastly, these findings have implications for the development of targeted interventions to mitigate the burden of NAFLD and AF in the HIV population, ultimately improving the overall health outcomes of people with HIV.

References:

Lake JE, Allende DS, Cummings OW, et al. NAFLD and Advanced Fibrosis Are Common in Adults With HIV and Associated With Unique Histology. Conference Reports for NATAP. Accessed March 27, 2024. https://www.natap.org/2024/CROI/croi_74.htm.

NAFLD and advanced fibrosis are common in adults with HIV and associated with unique histology - croi conference. CROI Conference -. March 7, 2024. Accessed March 27, 2024. https://www.croiconference.org/abstract/nafld-and-advanced-fibrosis-are-common-in-adults-with-hiv-and-associated-with-unique-histology/.

van Welzen BJ, Mudrikova T, El Idrissi A, Hoepelman AIM, Arends JE. A review of non-alcoholic fatty liver disease in HIV-infected patients: The next big thing? PubMed Central. March 2019. Accessed March 27, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374241/.