Nonalcoholic Steatohepatitis and Hepatic Fibrosis in HIV-1–Monoinfected Adults With Elevated Aminotransferase Levels on Antiretroviral Therapy

Abstract

HIV-infected adults with chronic aminotransferase elevations while receiving ART have a high rate of liver disease. Noninvasive testing can help identify liver disease in such patients, but liver biopsy is necessary to definitively identify those at risk for liver disease progression and complications. Longitudinal follow-up of this cohort will better characterize the natural history of aminotransferase elevations in this population and identify noninvasive biomarkers of liver disease progression.

PNPLA3 gene in liver diseases

“…In patients with Wilson disease, carriers of the mutant rs738409[G] allele had a higher prevalence of steatosis [49]. In HIV mono-infected patients, rs738409 [G] has been associated with steatosis, NASH, and fibrosis [50,51]. Finally, PNPLA3 has been shown to increase the risk of hepatic steatosis/fibrosis in individuals with inflammatory bowel diseases [52].…”

Liver Test Abnormalities in Patients with HIV Mono-Infection: Assessment with Simple Non-Invasive Fibrosis Markers

“…Similarly, in a cohort of 225 HIV-mono-infected patients, 28 were classified as not having fibrosis on FIB-4 [23], while in another cohort of 62 patients FIB4 ≤1.45 and >3. 25 were found in 37 (59.7%) and 5 (8%) patients, respectively [22]. Conversely, a slightly higher prevalence of 8% of APRI values >1.5 was found in 432 HIV-mono-infected patients, and both diabetes and detectable HIV viremia were confirmed as risk factors for significant fibrosis [30].…”

“…Morse et al biopsied a cohort of 62 patients with similar features and found steatosis in 45 (73%), NASH in 34 (55%) and bridging fibrosis in 11 (17%) patients [22].…”

“…In our study, the duration of ART was the only factor independently associated with the presence of fibrosis based on FIB-4. The impact of ART on liver fibrosis is controversial, as highlighted by conflicting reports on worsening with long-term use of ART, especially didanosine or stavudine [9,31], absence of significant effect [22], or even improvement following commencement of PIs [32,33]. Furthermore, Mendeni et al followed a cohort of 1112 HIV-mono-infected patients for approximately 6 years and found that progression of fibrosis, assessed by APRI and FIB4, was prevented by viral control with early ART, provided that didanosine use was avoided [33].…”

La steatosi epatica non alcolica in HIV: una revisione critica della letteratura.

“…review o ispanica come fattori di rischio nello sviluppo di NAFLD (1,6). La prevalenza di NAFLD nelle persone con infezione da HIV (PLHIV) su biopsie epatiche di pazienti con ipertransaminasemia è risultata elevata (>50%) con un'alta percentuale di NASH (7)(8)(9)(10)(11)(12). Considerando le diagnosi eseguite con metodiche diagnostiche non invasive (ecografia, fibroscan, TAC e risonanza magnetica) la prevalenza di NAFLD si aggira tra il 13% e il 58% nei diversi studi pubblicati (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”