Objective:To assess the role of TE in HIV infected patients with NAFLD.
Methods: HIV infected patients undergoing ART were enrolled between August2016 and February2017. Inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria: pregnancy; alcohol intake ≥20g/day and co-infection with hepatitis B or C. Patients underwent abdominal US to diagnose liver steatosis. Significant fibrosis (≥F2) was considered when APRI>1.0, FIB4>3 and liver stiffness ≥7.1kPa. Subjects with TE ≥7.1kPa were proposed a liver biopsy and the NAFLD Scoring System ≥3 was considered as diagnosis of NASH. Poisson regression model was used to identify factors associated with liver steatosis.
Results: 98 patients were included. Mean age was 49±11 years and 53 (54.1%) were male. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male sex (PR= 2.18) and higher BMI (PR=1.08). Among the 31 patients with NAFLD, 26 had results for TE, APRI and FIB4. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients (26.9%) had a TE result ≥7.1kPa, which was associated with higher triglyceride levels, FIB4 score and CAP values. Six of those with TE ≥7.1kPa performed a liver biopsy and NASH was found in 5 (83.3%) and liver fibrosis without NASH in one.
Conclusions: NAFLD prevalence in HIV infected patients is higher than general population. TE ≥7.1kPa was not able to diagnose significant fibrosis, but accurately detect a subgroup of patients with high risk for NASH among HIV monoinfected individuals with steatosis.