Over half of mostly black US HIV group has NAFLD – and many have NASH
Prevalence of nonalcoholic fatty liver disease (NAFLD) lay above 50% in a two-thirds black HIV group in Newark, NJ, higher than the 43% prevalence reported in a largely white HIV group in Palermo, Italy. 
The US group had spent an average five more years on antiretroviral therapy (ART) than the Palermo group, and a higher proportion in the US cohort had diabetes. Prevalence of nonalcoholic steatohepatitis (NASH) was also higher in the US group.
A review of recent literature noted increasing reports of NAFLD and NASH in people with HIV infection . A Netherlands group proposed that insulin resistance, mitochondrial dysfunction, and dyslipidemia drive NAFLD pathogenesis and progression to NASH in people with HIV . But prevalence and risk factors for these conditions remain poorly understood, as does the potential impact of ART.
To learn more about NAFLD and NASH in ART-treated people, clinicians at Saint Michael’s Medical Center in Newark prospectively gathered data on HIV positive people undergoing transient elastography (TE) at their center from November 2017 to September 2018. They compared their findings with a recent report on NAFLD and NASH in HIV-monoinfected patients at the University Hospital of Palermo . The Newark team defined NAFLD and fibrosis severity by the same measures used in Palermo, Controlled Attenuation Parameter (CAP) above 248 dB/m and TE above 7.1 Kpa.
The Newark cohort included 624 consecutive patients with HIV, who did not differ significantly from the Palermo group in age or sex. NAFLD prevalence was high in both groups, but higher in Newark (51.6%) than in Palermo (42.7%). Among people with NAFLD, NASH prevalence was also higher in Newark (31%) than Palermo (23%).
The Newark and Palermo patient clusters differed in race (68% black in Newark, 87% white in Palermo), diabetes prevalence (20% in Newark, 6% in Palermo, although body mass index did not differ significantly between groups), and longer time on ART in Newark (average 5 years). The Newark team also noted trends in a lower percentage of patients with a viral load below 20 copies, a lower average CD4 count, a higher percentage taking integrase inhibitors, and a higher prevalence of hypertension in the Newark patients.
The Newark investigators concluded that the prevalence of NAFLD is alarmingly high in people with HIV. Gaining a better understanding of NAFLD in HIV patients is urgent, they stressed, “to prevent the potentially severe consequences of NASH”. Because their study suggested longer antiretroviral duration may favour development of NAFLD, the Newark team urged closer monitoring of liver health as soon as ART begins.
- Choe S et al. A comparison study of prevalence and risk factors for nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) by transient elastography (TE) in HIV infected patients. IDWeek, October 2-6, 2019, Washington, DC. Abstract 353.
http://natap.org/2019/IDWeek/IDWeek_09.htm (natap report)
- Rockstroh JK. Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) in HIV. Curr HIV/AIDS Rep. 2017;14:47-53.
- van Welzen BJ et al. A review of non-alcoholic fatty liver disease in HIV-infected patients: the next big thing? Infect Dis Ther. 2019;8:33-50.
- Mazzola G et al. Prevalence and severity of nonalcoholic fatty liver disease by transient elastography with controlled attenuation parameter: risk factors in unselected HIV mono-infected population. International Conference on Drug Therapy of HIV Infection, Glasgow, October 28-31, 2018.