Prevalence and Characteristics of Nonalcoholic Fatty Liver Disease and Fibrosis in People Living With HIV Monoinfection: A Systematic Review and Meta-analysis

Kalligeros, Markos; Vassilopoulos, Athanasios; Shehadeh, Fadi; Vassilopoulos, Stephanos P.; Lazaridou, Ingrid; Mylonakis, Eleftherios; Promrat, Kittichai; Wands, Jack R.

doi:10.1016/j.cgh.2023.01.001

Cited by 41 publications

(41 citation statements)

References 72 publications

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“…Incorporating the required cardiometabolic criteria for the definition of MASLD led to the assignment of cSLD phenotype in only 0.6% of PWH, a subgroup with that would have been included under the umbrella of NAFLD previously. Thus, consistent with other studies from the US and China in non‐HIV populations, 31,32 there is a minimal discrepancy between NAFLD and MASLD assignment using the new nomenclature.…”

Section: Discussionsupporting

confidence: 89%

Prevalence of steatotic liver disease, MASLD, MetALD and significant fibrosis in people with HIV in the United States

Gawrieh,

Vilar‐Gomez,

Woreta

et al. 2023

Aliment Pharmacol Ther

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SummaryBackgroundMetabolic dysfunction‐associated steatotic liver disease (MASLD) has recently been proposed as a replacement term for NAFLD.AimsTo assess the effects of this new nomenclature on the prevalence and distribution of different SLD categories in people with HIV (PWH) and identified factors associated with MASLD and clinically significant fibrosis (CSF).MethodsPWH were prospectively enrolled from 9 US centres and underwent clinical evaluation and vibration‐controlled transient elastography for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). SLD was defined as CAP ≥ 263 dB/m, CSF as LSM of ≥8 kPa, and advanced fibrosis (AF) as LSM ≥ 12 kPa. The prevalence of SLD, MASLD, metabolic dysfunction and alcohol‐associated liver disease (MetALD), ALD, cryptogenic (cSLD), CSF and AF were determined. Uni‐ and multivariate logistic regression models were used to assess factors associated with MASLD and CSF risk.ResultsOf 1065 participants, 74% were male, mean (SD) age 51.6 ± 11.9 years, 46% non‐Hispanic Black and 74% with undetectable HIV RNA. The prevalence of SLD was 52%, MASLD 39%, MetALD 10%, ALD 3%, CSF 15% and AF 4%. Only 0.6% had cSLD. Black race was protective whereas obesity, ALT and AST levels were associated with increased risk of MASLD and CSF in MASLD. HIV or antiretroviral therapy did not affect MASLD risk.ConclusionsMASLD and MetALD are the dominant causes of SLD in PWH, affecting almost half. Application of the new nomenclature resulted in minimal change in the proportion of patients with MASLD who would have been diagnosed previously with NAFLD.

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Section: Discussionsupporting

confidence: 89%

Prevalence of steatotic liver disease, MASLD, MetALD and significant fibrosis in people with HIV in the United States

Gawrieh,

Vilar‐Gomez,

Woreta

et al. 2023

Aliment Pharmacol Ther

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“…Long-term ART may be associated with metabolic disorders in people with HIV, including past use of firstgeneration NRTIs and ritonavir-boosted PIs [6,7]. Considering the propensity of people with HIV to develop NAFLD, it is important to determine the potential contribution of ART to HS [2,3]. The hepatotoxicity and metabolic profile of raltegravir, an INSTI, appears favourable [30].…”

Section: Discussionmentioning

confidence: 99%

“…Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, with a worldwide prevalence of 25% [1]. People with HIV have a higher prevalence of NAFLD at 35% [2,3]. This may be due to chronic inflammation related to HIV and the long-term use of antiretroviral therapy (ART) with longer lifespan, leading to an increased risk of age-related metabolic conditions [4,5].…”

Section: Introductionmentioning

confidence: 99%

Switch to a raltegravir‐based antiretroviral regimen in people with HIV and non‐alcoholic fatty liver disease: A randomized controlled trial

Shengir,

Lebouche,

Elgretli

et al. 2023

HIV Medicine

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IntroductionThe effect of antiretroviral therapy (ART), particularly integrase strand transfer inhibitors (INSTIs), on non‐alcoholic fatty liver disease (NAFLD) in people with HIV remains unclear. We evaluated the effect of switching non‐INSTI backbone antiretroviral medications to raltegravir on NAFLD and metabolic parameters.Materials and MethodsThis was a single‐centre, phase IV, open‐label, randomized controlled clinical trial. People living with HIV with NAFLD and undetectable viral load while receiving a non‐INSTI were randomized 1:1 to the switch arm (raltegravir 400 mg twice daily) or the control arm (continuing ART regimens not containing INSTI). NAFLD was defined as hepatic steatosis by controlled attenuation parameter ≥238 dB/m in the absence of significant alcohol use and viral hepatitis co‐infections. Cytokeratin 18 was used as a biomarker of non‐alcoholic steatohepatitis. Changes over time in outcomes were quantified as standardized mean differences (SMDs), and a generalized linear mixed model was used to compare outcomes between study arms.ResultsA total of 31 people with HIV (mean age 54 years, 74% male) were randomized and followed for 24 months. Hepatic steatosis improved between baseline and end of follow‐up in both the switch (SMD −43.4 dB/m) and the control arm (−26.6 dB/m); the difference between arms was not significant. At the end of follow‐up, aspartate aminotransferase significantly decreased in the switch arm compared with the control arm (SMD −9.4 vs. 5.5 IU/L). No changes in cytokeratin 18, body mass index, or lipids were observed between study arms.DiscussionSwitching to a raltegravir‐based regimen improved aspartate aminotransferase but seemed to have no effect on NAFLD, body weight, and lipids compared with remaining on any other ART.

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“…[2] A recent meta-analysis showed a pooled prevalence of NAFLD and significant liver fibrosis of 34% and 12% in HIV mono-infected patients, respectively. [3] The reasons for this increased burden are related to the more complex pathogenesis of liver disease. First, PWH has an excess prevalence of classical metabolic risk factors driving the pathogenesis of NAFLD and associated liver fibrosis.…”

mentioning

confidence: 99%

“…Surprisingly, people living with HIV (PWH) are not included among at-risk patient populations who should be screened, despite preponderant evidence about the increased frequency and severity of NAFLD 2 . A recent meta-analysis showed a pooled prevalence of NAFLD and significant liver fibrosis of 34% and 12% in HIV mono-infected patients, respectively 3 …”

mentioning

confidence: 99%

Letter to the Editor: People living with HIV and NAFLD—A population left behind in the global effort for liver fibrosis screening?

Sebastiani,

Milic,

Tsochatzis

et al. 2023

Hepatology

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Prevalence and Characteristics of Nonalcoholic Fatty Liver Disease and Fibrosis in People Living With HIV Monoinfection: A Systematic Review and Meta-analysis

Cited by 41 publications

References 72 publications

Prevalence of steatotic liver disease, MASLD, MetALD and significant fibrosis in people with HIV in the United States

Prevalence of steatotic liver disease, MASLD, MetALD and significant fibrosis in people with HIV in the United States

Switch to a raltegravir‐based antiretroviral regimen in people with HIV and non‐alcoholic fatty liver disease: A randomized controlled trial

Letter to the Editor: People living with HIV and NAFLD—A population left behind in the global effort for liver fibrosis screening?

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