Prevalence and Risk Factors of Liver Fibrosis in People Living with HIV/Acquired Immunodeficiency Syndrome

With Antiretroviral therapy (ART), life expectancy in people living with HIV/acquired immunodeficiency syndrome (PLHA) has improved, shifting focus to complications like liver fibrosis. Contributing factors include HIV, ART-related metabolic changes, chronic inflammation, and co-infections (hepatitis B virus [HBV]/hepatitis C virus). However, HIV's independent role in fibrosis without traditional risk factors remains unclear. This study estimated liver fibrosis prevalence among PLHA in North India and identified associated risk factors.

A cross-sectional study was conducted over 18 months at a tertiary ART center, including 354 PLHA. Liver fibrosis was assessed using FibroScan^® and categorized into stages F0-F4. Laboratory tests included liver function, lipid profile, fasting glucose, glycated hemoglobin, and CD4 count. Metabolic syndrome was defined using the modified Adult Treatment Panel III of the National Cholesterol Education Program criteria. Statistical methods included Chi-square tests, Spearman correlation, and logistic regression.

The mean liver stiffness was 6.27 ± 1.87 kPa. Fibrosis stages included: F0-F1 (81.4%), F2 (13.6%), F3 (4.5%), and F4 (0.6%). Among HIV monoinfected patients without conventional risk factors, 12% had significant fibrosis, compared to 34% with risk factors (P < 0.001). Metabolic syndrome was the strongest independent predictor (Odds ratio = 27.86, P < 0.001). A negative correlation was observed between high-density lipoprotein and liver stiffness (ρ = -0.29, P < 0.001). No significant association was found with ART regimen, CD4 count, or viral load.

Liver fibrosis was present in 18.7% of PLHA. Metabolic syndrome, diabetes, and HBV were key contributors. Routine fibrosis screening should be part of HIV care.