HIV Infection Does Not Affect Hepatic Steatosis or Fibrosis

Introduction: Data regarding a direct role of human immunodeficiency virus (HIV) infection in the pathogenesis of hepatic steatosis and fibrosis in the era of the modern antiretroviral therapy are limited. The objective is to compare the prevalence and severity of hepatic steatosis and advanced fibrosis in HIV-infected and control outpatients. Methods: We conducted a cross-sectional analysis of relevant data in an HIV-dedicated outpatient clinic and an adult primary care clinic of an inner-city hospital. Hepatic Steatosis Index (HSI) and FIB-4 index were calculated as non-invasive measures of steatosis and fibrosis, respectively, in 875 pairs of individuals. Multivariate logistic regression analysis was performed to assess predictors of steatosis and advanced fibrosis. Results: The prevalence of hepatic steatosis, determined by HSI ≥ 36, was higher in HIV-negative patients (71.5% vs 65.4%, p=0.006). Multivariable analysis did not reveal an independent association between HIV infection and hepatic steatosis (p=0.068). Advanced fibrosis prevalence, determined by FIB-4 ≥ 3.25, was higher in the HIV-positive group (7% vs 1.7%, p<0.001). In the multivariate analysis, independent factors associated with higher odds of advanced fibrosis were hepatitis B infection (OR=2.82, CI=1.02-7.85, p=0.05) and hepatitis C infection (OR=8.35, CI=4.48-14.54, p<0.001). HIV was not an independent risk factor for advanced fibrosis. Conclusion: In the cohort of HIV-infected individuals, we found a lower prevalence of hepatic steatosis calculated by HSI compared with non-HIV individuals despite a higher prevalence of HCV seropositivity. In addition, HCV infection was inversely associated with hepatic steatosis by multiple regression analysis. Advanced fibrosis had a higher prevalence in HIV-infected patients compared to the non-HIV cohort. The main factor associated with increased prevalence of fibrosis was higher rates of HCV infection in the HIV-infected individuals. HIV itself was not an independent risk factor for advanced fibrosis.977_A Figure 1 No Caption available.977_B Figure 2 No Caption available.977_C Figure 3 No Caption available.