Hepatic steatosis and NAFLD are common and associated with cardiometabolic risk in a primary prevention cohort of people with HIV
Abstract
Background Hepatic steatosis, including non-alcoholic fatty liver disease (NAFLD), is common among people with HIV (PWH). We present baseline steatosis prevalence and cardiometabolic characteristics among REPRIEVE substudy participants.
Methods REPRIEVE is an international, primary cardiovascular disease prevention, randomized, controlled trial of pitavastatin calcium vs. placebo among 7,769 PWH ages 40-75 years on antiretroviral therapy (ART) and with low-to-moderate cardiovascular risk. A subset of participants underwent non-contrast computed tomography, with hepatic steatosis defined as mean hepatic attenuation <40 HU or liver/spleen ratio <1.0, and NAFLD defined as steatosis in the absence of frequent alcohol use or viral hepatitis.
Results Of 687 evaluable persons, median age was 51 years, BMI 27 kg/m2, CD4+ T cell count 607 cells/mm3; 17% natal female sex, 36% Black, 24% Hispanic, and 98% HIV-1 RNA <400 copies/mL. Hepatic steatosis prevalence was 22% (149/687), and NAFLD 21% (96/466). Steatosis/NAFLD prevalence was higher in males and with older age, non-Black race, and higher BMI and waist circumference. Both were associated with BMI >30 kg/m2, Metabolic Syndrome components, higher ASCVD risk score, HOMA-IR, LpPLA-2 and hs-CRP, and lower high-density lipoprotein cholesterol. Of HIV-/ART-specific characteristics, only history of an AIDS-defining illness was more common among persons with steatosis/NAFLD. After adjusting for age, sex and race/ethnicity, BMI >30 kg/m2, HOMA-IR >2.0, Metabolic Syndrome and each of its components were associated with NAFLD prevalence.
Conclusion In this cohort with controlled HIV and low-to-moderate cardiovascular risk, hepatic steatosis and NAFLD were common and associated with clinically relevant metabolic and inflammatory disturbances, but not current HIV- or ART-related factors.