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Non-viral Liver Disease Burden in HIV
Mono-infected Individuals: A Prospective Cohort Study

  Reported by Jules Levin
EACS - European AIDS Conference, Oct 20-24 Milan, Italy


Program Abstract
Liver disease in the absence of viral hepatitis co-infection is a growing problem in HIV positive individuals. Possible causes include alcohol, non-alcoholic fatty liver disease, and antiretroviral therapy (ART). We aimed to assess the prevalence of clinically significant hepatic fibrosis (CSHF) and associated risk factors in HIV mono-infected individuals with abnormal liver tests.
Methods: HIV mono-infected individuals with elevated transaminases for ≥6 months were identified. Consenting individuals were prospectively assessed using transient elastography, Alcohol Use Disorders Identification Test (AUDIT) questionnaire, and screening for metabolic syndrome (MS). Thresholds for CSHF and hepatic steatosis (HS) were liver stiffness measurement (LSM) ≥7.1kPa and controlled attenuation parameter (CAP) ≥237dB/m respectively.
Results: Of 425 eligible individuals, 90 have been recruited to date. Baseline characteristics of those with and without CSHF were similar (Table 1). HS was seen in 46 (51.1%). Twenty (22.2%) had CSHF of whom 10 (50%) also had HS and four (20%) had cirrhosis (LSM >11.5kPa). Likely risk factors for CSHF are outlined in Table 2. There were no differences in ART use (including didanosine, stavudine, nevirapine and efavirenz) in those with and without CSHF. On binary logistic regression lower HDL cholesterol was the only independent predictive of CSHF (HR 0.145, 95% CI 0.025-0.841, P=0.031). Both FIB-4 and APRI performed poorly in identifying CSHF (AUROC 0.477 and 0.462 respectively).