Prevalence and risk factors for significant liver fibrosis among HIV-monoinfected patients

Abstract

BackgroundHIV-monoinfected patients may be at risk for significant liver fibrosis, but its prevalence and determinants in these patients are unknown. Since HIV-monoinfected patients do not routinely undergo liver biopsy, we evaluated the prevalence and risk factors of significant hepatic fibrosis in this group using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI).MethodsWe conducted a cross-sectional study among HIV-infected patients negative for hepatitis B surface antigen and hepatitis C antibody in the Penn Center for AIDS Research Adult/Adolescent Database. Clinical and laboratory data were collected from the database at enrollment. Hypothesized determinants of significant fibrosis were modifiable risk factors associated with liver disease progression, hepatic fibrosis, or hepatotoxicity, including immune dysfunction (i.e., CD4 T lymphocyte count <200 cells/mm3, HIV viremia), diseases associated with hepatic steatosis (e.g., obesity, diabetes mellitus), and use of antiretroviral therapy. The primary outcome was an APRI score >1.5, which suggests significant hepatic fibrosis. Multivariable logistic regression identified independent risk factors for significant fibrosis by APRI.ResultsAmong 432 HIV-monoinfected patients enrolled in the CFAR Database between November 1999 and May 2008, significant fibrosis by APRI was identified in 36 (8.3%; 95% CI, 5.9 - 11.4%) patients. After controlling for all other hypothesized risk factors as well as active alcohol use and site, detectable HIV viremia (adjusted OR, 2.56; 95% CI, 1.02 - 8.87) and diabetes mellitus (adjusted OR, 3.15; 95% CI, 1.12 - 10.10) remained associated with significant fibrosis by APRI.ConclusionsSignificant fibrosis by APRI score was found in 8% of HIV-monoinfected patients. Detectable HIV viremia and diabetes mellitus were associated with significant fibrosis. Future studies should explore mechanisms for fibrosis in HIV-monoinfected patients.

Prevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth

“…Our findings were generally consistent with those from other studies[23, 25, 29]. In their evaluation of FIB-4 markers in HIV mono-infected women, the associations of low CD4 count, detectable viral load and ART use in the study of Blackard, et al were consistent with our findings[23].…”

Elevated Aspartate Aminotransferase-to-Platelet Ratio Index in Perinatally HIV-Infected Children in the United States

“…In addition, the lack of APRI elevation risk associated with ARV treatment duration or specific ARV classes and agents affirms findings in studies of HIV mono-infected adults that chronic ARV treatment does not increase the risk of elevated APRI [8–10]. The 0.8% prevalence of APRI > 1.5 in this pediatric cohort appears lower than rates of 3.0–3.9% reported in several studies of HIV-infected adults [7–9] and much lower than the 8% rate observed in one adult study [10]. This lower prevalence among HIV-infected children is likely attributable to lower rates in HIV-infected children compared to HIV-infected adults of other factors that contribute to liver problems, such as viral hepatitis and alcohol use (only 36% of perinatal HIV AMP participants reported alcohol use [11]).…”

“…The small magnitude of the risk of APRI elevation is largely reassuring about the status of liver health in perinatally HIV-infected children but this optimistic interpretation is tempered by the relatively low sensitivity of these APRI cut-offs for detecting liver fibrosis in children [6]. In addition, the lack of APRI elevation risk associated with ARV treatment duration or specific ARV classes and agents affirms findings in studies of HIV mono-infected adults that chronic ARV treatment does not increase the risk of elevated APRI [8–10]. The 0.8% prevalence of APRI > 1.5 in this pediatric cohort appears lower than rates of 3.0–3.9% reported in several studies of HIV-infected adults [7–9] and much lower than the 8% rate observed in one adult study [10].…”

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

“…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]. However, the presence of obesity in 50% of the cohort could have contributed to the higher prevalence of significant fibrosis.…”