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Prevalence, predictors, and severity of lean nonalcoholic fatty liver disease in patients living with human immunodeficiency virus

  • Authors: Cervo A.; Milic J.; Mazzola G.; Schepis F.; Petta S.; Krahn T.; Lebouche B.; Deschenes M.; Cascio A.; Guaraldi G.; Sebastiani G.
  • Publication year: 2020
  • Type: Articolo in rivista
  • OA Link:


Background. The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV. Methods. We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients. Results. We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04–1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11–1.63), and high ALT (aOR, 1.15; 95% CI, 1.05–1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26–.77). Conclusions. NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.