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Brief Report: Relationship Between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease in Persons With HIV
Alyson Kaplan1,2, Tracey G Simon2, Jacqueline B Henson2
1Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY.
Insights
Nonalcoholic fatty liver disease (NAFLD) is more common in people with HIV and linked to higher cardiovascular disease (CVD) risk. NAFLD may also indicate immune dysfunction in this population.
Area of Science:
- Cardiology
- Hepatology
- Infectious Diseases
Background:
- Nonalcoholic fatty liver disease (NAFLD) and HIV are independent risk factors for cardiovascular disease (CVD).
- The association between NAFLD and CVD in people with HIV (PWH) is not well understood.
- Factors contributing to NAFLD in PWH require investigation.
Purpose of the Study:
- To determine the prevalence of NAFLD in people with HIV (PWH).
- To investigate the association between NAFLD and cardiovascular disease (CVD) in PWH.
- To identify factors associated with NAFLD in PWH.
Main Methods:
- Retrospective cohort study of PWH with and without NAFLD (2010-2017).
- NAFLD diagnosed via histological or radiographic criteria.
- CVD diagnosed by ICD-9 codes and confirmed by clinician review; multivariable logistic regression used.
Main Results:
- PWH with NAFLD had higher BMI, hypertension, sleep apnea, diabetes, dyslipidemia, coronary artery disease, and CVD.
- NAFLD was significantly associated with CVD (aOR 3.08) and low CD4 counts (<200 cells/mm, aOR 4.49).
- PWH with NAFLD were more likely to have CD4 counts <200 cells/mm.
Conclusions:
- NAFLD is independently associated with prevalent CVD in PWH, even after accounting for traditional risk factors.
- NAFLD in PWH is linked to lower CD4 counts, suggesting a potential role for immune dysfunction.
- Further prospective studies are needed to evaluate CVD and low CD4 counts as risk factors for NAFLD.
Background:
Nonalcoholic fatty liver disease (NAFLD) and HIV are independently associated with cardiovascular disease (CVD). However, the factors associated with NAFLD in persons living with HIV (PWH) and whether CVD is more frequent in PWH with NAFLD are currently unknown.
Methods:
From the Partners HealthCare Research Patient Data Registry, we identified PWH with and without NAFLD between 2010 and 2017. NAFLD was defined using validated histological or radiographic criteria. CVD was defined by an ICD-9 diagnosis of coronary artery disease, myocardial infarction, coronary revascularization, peripheral vascular disease, heart failure, transient ischemic attack, or stroke and was confirmed by clinician review. Multivariable logistic regression was performed to examine the relationship between NAFLD and CVD.
Results:
Compared with PWH without NAFLD (n = 135), PWH with NAFLD (n = 97) had higher body mass index and more frequently had hypertension, obstructive sleep apnea, diabetes mellitus, dyslipidemia, coronary artery disease, and CVD (P < 0.01 for all). PWH with NAFLD were also more likely to have CD4 T-cell counts (CD4) <200 cells/mm. In multivariable models, the presence of NAFLD was significantly associated with CVD (adjusted odds ratio 3.08, 95% confidence interval: 1.37 to 6.94) and CD4 <200 cells/mm (adjusted odds ratio 4.49, 95% confidence interval: 1.74 to 11.55).
Conclusion:
In PWH, CVD was independently associated with prevalent NAFLD after controlling for traditional CVD risk factors. NAFLD was also associated with CD4 <200 cells/mm, suggesting that immune dysfunction may be related to NAFLD. Both CVD and low CD4 count as risk factors for NAFLD require prospective evaluation.
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