Prevalence of hepatic steatosis and advanced fibrosis in patients living with HIV in Germany

Background The prevalence of advanced liver disease and hepatic steatosis in patients living with HIV is poorly defined. An independent risk of HIV infection or antiretroviral therapy (ART) has been proposed.

Aims The current analysis explored hepatic steatosis and fibrosis stages defined by transient elastography in patients living with HIV.

Methods In this cross-sectional study, 280 patients with an HIV monoinfection were prospectively enrolled and liver steatosis as well as liver fibrosis were measured with transient elastography (TE). Based on controlled attenuation parameter (CAP; db/m) and liver stiffness measurement (LSM; kPa), patients were analyzed according to the presence of steatosis (> 280 db/m) or relevant fibrosis (> 8.2 kPa). Independent predictors of liver steatosis and fibrosis were identified using linear regression models. To identify patients with NASH and at least F2 fibrosis, the FAST-score was calculated.

Results In this cohort of 280 patients with HIV monoinfection on ART, the prevalence of liver steatosis was 34.3 % (n = 96) and the prevalence of relevant liver fibrosis was 7.1 % (n = 20). Among these patients, 28 (10 %) exhibited severe steatosis (CAP > 337 db/m) and 13 (4.6 %) had advanced fibrosis (E > 9.7 kPa). The FAST-score (cutoff > 0.35) identified 32 (12.4 %) patients. Multivariable regression analysis revealed ALT and waist-circumference (cm) as independent risk factors for higher degree steatosis and fibrosis, respectively. In general, factors associated with the metabolic syndrome were more common in patients with relevant steatosis and fibrosis. Patients with liver fibrosis showed a longer disease duration in comparison to those with no fibrosis (22 years vs 10 years, p < 0.05).

Conclusion Hepatic steatosis is highly prevalent among patients living with HIV and compared to epidemiological studies patients with steatosis and relevant fibrosis were younger. This study identified modifiable and preventable risk factors. Addressing these factors by education may support metabolic health in patients living with HIV.

Publication History

Article published online:
07 September 2021