Hepatic steatosis and nonalcoholic fatty liver disease are common and associated with cardiometabolic risk in a primary prevention cohort of people with HIV.

Abstract

BACKGROUND:

Hepatic steatosis, including nonalcoholic fatty liver disease (NAFLD), is common among people with HIV (PWH). We present baseline steatosis prevalence and cardiometabolic characteristics among REPRIEVE substudy participants.

METHODS:

REPRIEVE is an international, primary cardiovascular disease prevention, randomized, controlled trial of pitavastatin calcium vs. placebo among 7769 PWH ages 40-75 years on antiretroviral therapy (ART) and with low-to-moderate cardiovascular risk. A subset of participants underwent noncontrast computed tomography, with hepatic steatosis defined as mean hepatic attenuation less than 40 HU or liver/spleen ratio less than 1.0, and NAFLD defined as steatosis in the absence of frequent alcohol use or viral hepatitis.

RESULTS:

Of 687 evaluable persons, median age was 51 years, BMI 27 kg/m 2 , CD4 + T-cell count 607 cells/μl; 17% natal female sex, 36% Black, 24% Hispanic, and 98% HIV-1 RNA less than 400 copies/ml. Hepatic steatosis prevalence was 22% (149/687), and NAFLD 21% (96/466). Steatosis/NAFLD prevalence was higher in men and with older age, non-Black race, and higher BMI and waist circumference. Both were associated with BMI greater than 30 kg/m 2 , metabolic syndrome components, higher atherosclerotic cardiovascular disease (ASCVD) risk score, HOMA-IR, LpPLA-2 and hs-CRP, and lower high-density lipoprotein cholesterol. Of HIV-specific/ART-specific characteristics, only history of an AIDS-defining illness was more common among persons with steatosis/NAFLD. After adjusting for age, sex and race/ethnicity, BMI greater than 30 kg/m 2 , HOMA-IR greater than 2.0, Metabolic syndrome and each of its components were associated with NAFLD prevalence.

CONCLUSION:

In this cohort with controlled HIV and low-to-moderate cardiovascular risk, hepatic steatosis and NAFLD were common and associated with clinically relevant metabolic and inflammatory disturbances but not current HIV-related or ART-related factors.

• Authors: Jordan E Lake, Jana Taron, Heather J Ribaudo, Jorge Leon-Cruz, Netanya S Utay, Shobha Swaminathan, Kathleen V Fitch, Emma M Kileel, Kayla Paradis, Evelynne S Fulda, Ken S Ho, Anne F Luetkemeyer, Carrie D Johnston, Markella V Zanni, Pamela S Douglas, Steven K Grinspoon, Michael T Lu, Carl J Fichtenbaum, REPRIEVE Trial Investigators
• Journal: AIDS (London, England) (AIDS) Vol. 37 Issue 14 Pg. 2149-2159 (11 15 2023) ISSN: 1473-5571 [Electronic] England
• PMID: 37503623 (Publication Type: Randomized Controlled Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Female
• Humans
• Male
• Middle Aged
• Cardiovascular Diseases (epidemiology, prevention & control, complications)
• HIV Infections (complications, drug therapy, epidemiology)
• Metabolic Syndrome (complications, epidemiology)
• Non-alcoholic Fatty Liver Disease (complications, epidemiology)
• Primary Prevention
• Adult
• Aged