Satyajit Das, HIV i-Base

Non Alcoholic Fatty Liver Disease (NAFLD) is the most common form of liver disease among the general population. Crum-Cianflone and colleagues reported results from a cross-sectional study of 300 HIV-positive patients (who were not infected with hepatitis B or C, or reported significant alcohol use) to determine the prevalence and factors associated with NAFLD.

NAFLD was diagnosed by ultrasound examination and liver biopsies were performed on a subset of participants. Thirty-one percent (67/216) of HIV patients had NAFLD on ultrasound. Demographics included mean age 40 years; male 94%; 48% Caucasian, 27% African American, and 25% other. Mean duration of HIV infection was 10 years, mean CD4 count was 535 cells/mm3, and 65% were receiving antiretroviral therapy.

Factors associated with NAFLD in the multivariate model included increased waist circumference, elevated serum triglycerides, and lower HDL levels. African Americans were significantly less likely to have NAFLD compared to Caucasians (14% vs. 35%, p=0.05). Analyses were repeated for those with NALFD on liver biopsy with similar results. HIV-specific factors such as CD4 cell count, viral load, HIV duration, and ART were not independent factors associated with NAFLD.

Increased waist circumference, elevated serum triglycerides, and lower HDL levels, all are markers of metabolic syndrome. These data suggest that weight and lipid management may be key factors for the prevention of liver disease due to NAFLD among HIV patients.

Ref: Crum-Cianflone NF et al. Nonalcoholic Fatty Liver Disease (NAFLD) among HIV-Infected Persons. 48th ICAAC, 25-28 October 2008. Washington. Abstract: H 2322.