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HIV an independent risk factor for nonalcoholic steatohepatitis



Disclosures:
Price reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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A study of more than 1,300 women demonstrated that HIV is an independent risk factor for nonalcoholic steatohepatitis with significant nonalcoholic fatty liver disease activity and fibrosis, researchers reported.

Nonalcoholic fatty liver disease (NAFLD) is common among people with and without HIV and is a leading cause of liver-related morbidity and mortality,” Jennifer C. Price, MD, PhD, associate professor of medicine at the University of California, San Francisco, told Healio. “However, most patients with NAFLD do not go on to develop cirrhosis.”

Women living with HIV faced a higher risk for nonalcoholic steatohepatitis with significant nonalcoholic fatty liver disease activity and fibrosis. Source: Adobe Stock.

Women living with HIV faced a higher risk for nonalcoholic steatohepatitis with significant nonalcoholic fatty liver disease activity and fibrosis. Source: Adobe Stock.

According to Price, the FibroScan-AST (FAST) score can identify patients at risk for developing cirrhosis, or those with nonalcoholic steatohepatitis with an elevated NAFLD activity score and significant liver fibrosis.

“The advantage of the FAST score is that it does not require liver biopsy,” Price said. “We conducted this study to see if HIV was independently associated with higher risk of an elevated FAST score in a cohort of women with and without HIV.”

Jennifer C. Price, MD, PhD

Jennifer C. Price

Price and colleagues assessed 1,309 women without history of chronic viral hepatitis at 10 U.S. sites 928 with HIV and 381 who were HIV negative — and evaluated associations between HIV, demographic, lifestyle and metabolic factors with a FAST score higher than 0.35, which is considered elevated.

Women with HIV were more likely to have an elevated FAST score compared with those without HIV (6.3% vs 1.8%; P = .001). The researchers calculated that HIV infection was associated with 3.7-fold higher odds of elevated FAST score (P = .002), whereas a greater waist circumference was associated with 1.7-fold higher odds per each 10 cm (P < .001).

The study also showed that undetectable HIV RNA and current protease inhibitor use were independently associated with lower odds of elevated FAST score.

“HIV may increase the risk of more advanced NAFLD histology and liver disease progression,” Price said. “Unsuppressed HIV viral load and increased waist circumference are risk factors for elevated FAST in women, underscoring the importance of ART adherence and weight management in clinical practice.”



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