Prevalence and Associated Factors of Non-Alcoholic Fatty Liver Disease in People Living with HIV-1

Modern antiretroviral therapy (ART) prevents disease progression in people living with HIV. Due to the increasing age of people living with HIV, the detection and management of comorbidities has become more important.

In this study, we aimed to detect the prevalence of nonalcoholic fatty liver disease (NAFLD) and associated risk factors among people living with HIV followed up in our center.

This single-center, cross-sectional study included people living with HIV, on ART for ≥1 year and virologic suppression for ≥6 months, presenting for routine follow-up between October 1, 2021, and April 1, 2022. Participants with a concurrent etiology for hepatic steatosis were excluded. Transient elastography (TE) was performed. NAFLD was defined as a controlled attenuation parameter (CAP) ≥248 dB/m; significant fibrosis (≥F2) was defined as liver stiffness measurement ≥7.1 kPa.

A total of 102 people living with HIV (84% men; median age, 39 years (IQR 33-52.5)) were enrolled. The treatment regimen of all participants included a nucleos(t)ide reverse transcriptase inhibitor and an integrase strand transfer inhibitor. TE analysis indicated NAFLD in 28 (27.5%) and fibrosis in 9 (8.8%; 6 with NAFLD) participants. In multivariable analysis, type two diabetes (OR:5.7 (95% CI 1.4-22.2), p=0.013), larger waist circumference (OR:1.1 (95% CI 1.03-1.16), p=0.007), higher alanine aminotransferase (OR:1.05 (95% CI 1.01-1.09), p=0.018), and higher thyroid stimulating hormone (OR:3.1 (95% CI 1.4-6.8), p=0.005) were independently associated with NAFLD.

We observed a significant prevalence of NAFLD among people living with HIV followed up in our center. The high prevalence of NAFLD in our sample mirrors that of the general population, likely due to rising rates of metabolic dysfunction. Our findings highlight the importance of timely screening and implementation of management strategies for NAFLD in this population.