Diagnostic Accuracy of Noninvasive Markers of Steatosis, NASH, and Liver Fibrosis in HIV-Monoinfected Individuals at Risk of Nonalcoholic Fatty Liver Disease (NAFLD): Results From the ECHAM Study

Abstract

Background: HIV-monoinfected individuals are at high risk of nonalcoholic fatty liver disease. Noninvasive tests of steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), FibroScan/controlled attenuation parameter (CAP), and biochemical tests. Methods: We enrolled antiretroviral therapy–controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, FibroScan/CAP, FibroTest/NashTest/SteatoTest, APRI, FIB-4, and nonalcoholic fatty liver disease–fibrosis score. A LB was indicated if suspected significant fibrosis (FibroScan ≥7.1 kPa and/or FibroTest ≥0.49). Performance was considered as good if area under a receiver operating characteristic curves (AUROCs) was >0.80. Results: Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age of 54 years (53–65), body mass index: 26 kg/m2 (24–30), steatosis in 37 (76%), NASH in 23 (47%), and fibrosis in 31 (63%) patients [F2: 7 (14%); F3: 6 (12%); and F4: 2 (4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROCs at 0.98 (95% confidence interval: 0.96 to 1.00) and 0.88 (0.76 to 0.99), respectively, whereas the AUROCs of SteatoTest was 0.68 (0.51 to 0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROCs at 0.86 (0.74 to 0.98) and 0.81 (0.67 to 0.95). By contrast, FibroScan and FibroTest had poor AUROCs [0.61 (0.43 to 0.79) and 0.61 (0.44 to 0.78)], with very low specificity. Regarding NASH, alanine aminotransferase ≥36 IU/L had good performance with AUROCs of 0.83 (0.71 to 0.94), whereas the NashTest had an AUROC of 0.60 (0.44 to 0.76). Conclusions: In HIV-monoinfected patients, MRI-PDFF and FibroScan/CAP are highly accurate for the diagnosis of steatosis. The alanine aminotransferase level and APRI should be considered for the detection of NASH and fibrosis.

HIV and antiretroviral therapy-related fat alterations

“…In addition, intramuscular fat accumulation has previously been reported in PLWH with lipoatrophy and/or lipohypertrophy 81 , and increased fatty infiltration of the thigh muscle was found to be associated with ageing independent of fat distribution 82 . Increased hepatic fat content has also been observed in PLWH with lipoatrophy 83 or in those with increased central adiposity 84 . Interestingly, and unique to PLWH, a parabolic association between SAT and liver fat has been observed, indicating high levels of steatosis in people with lipoatrophy and in those with increased subcutaneous adiposity 83 .…”

New Drugs for NASH and HIV Infection: Great Expectations for a Great Need

“…( 12,13 ) In the general population, the prevalence of lean NAFLD ranges between 7% in the United States to 19% in Asia, ( 14 ) with cohort studies suggesting that it might be higher in PLWH. ( 15,16 )…”

Hypogonadism and liver fibrosis in HIV-infected patients

“…However, also these methods have limitations: ultrasonography has limited accuracy in detecting fatty liver when < 35% of hepatocytes have been affected [36], and performing liver biopsy for patients who do not meet indications raises ethical considerations. Given the limitations of instrumental and histological methods for measurement of liver fibrosis, scores based on serum markers have been demonstrated good tools for the prediction of severity of liver fibrosis [37] and are widely used both in the general population and in HIV-infected patients [21,36,[38][39][40].…”