Background: HIV infection is one of the most important health problems worldwide. With effective antiretroviral therapy (ART), the mortality rate of HIV-infected patients has significantly declined. Currently, metabolic complications become more common and lead to increasing morbidity and mortality in HIV-infected patients. Non-alcoholic fatty liver disease (NAFLD) has emerged as a common metabolic complication in these patients. Our study was aimed to determine the prevalence and predicting factors of NAFLD in HIV-infected population.
Methods: A cross-sectional study was conducted in HIV-infected patients receiving ART without history of regular alcohol consumption or known chronic liver diseases. The data of demographic and clinical parameters, metabolic profiles, bioelectrical impedance analysis, liver ultrasonography and transient elastography (TE) with controlled attenuation parameter (CAP) were collected. The prevalence and predicting factors of NAFLD were analyzed. NAFLD was defined when CAP ≥248 dB/m. Patients were categorized into two groups: NAFLD and non-NAFLD. Significant liver fibrosis was defined when liver stiffness measurement (LSM) >7.0 kPa. Predicting factors of NAFLD were determined using logistic regression analysis.
Results: A total of 150 patients were included in the study. Forty-eight (32.0%) patients had NAFLD. Among this group, significant fibrosis was diagnosed in 5 (10.4%) patients and steatosis by ultrasonography was documented in 31 (64.6%) patients. Baseline characteristics including age, sex, CD4 cell count, types of ART regimens and duration of ART between the two groups were not different (p>0.05). Blood pressure, waist circumference, body mass index (BMI), percentage of fat, AST, ALT, HbA1c, LDL, and triglycerides were higher in the NAFLD group (p<0.05). By multivariate analysis, high BMI [odds ratio (OR) 1.596; 95% confidence interval (CI), 1.336-1.907, p<0.001], triglycerides level more than 150 mg/dl [OR 3.722; 95% CI, 1.508-9.187, p<0.004] and advance age [OR 1.076; 95% CI, 1.017-1.139, p<0.011] were predicting factors of NAFLD.
Conclusions: NAFLD is commonly found in HIV-infected patients receiving ART while significant fibrosis is relatively uncommon. High BMI, age and triglycerides appear to be predicting factors of NAFLD. The regimen and duration of ART are not associated with NAFLD. Screening for NAFLD by TE with CAP in HIV-infected patients should be recommended for early detection of NAFLD.