Assessment of the Association of HIV Infection with Hepatic Steatosis or Fibrosis: a Cross-Sectional, Case-Control Study

Abstract Background: Human immunodeficiency virus (HIV) infection and antiretroviral therapy have been associated with non-alcoholic fatty liver disease (NAFLD), but few studies have evaluated whether HIV infection is an independent risk factor for the development of hepatic steatosis and advanced liver fibrosis. Objectives: To study the prevalence and severity of hepatic steatosis and advanced fibrosis in people living with HIV and control outpatients. Methods: We conducted a cross-sectional analysis of relevant data from 875 pairs of individuals belonging to 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. A 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 subjects (71.5% vs. 65.4%, p=0.006). The prevalence of advanced fibrosis, determined by FIB-4 index ≥3.25, was higher in the HIV-positive group (7% vs. 1.7%, p <0.001). Multivariable analysis did not identify HIV infection to be an independent risk factor for hepatic steatosis (p=0.068) and advanced fibrosis. Conclusions: In this cohort, hepatic steatosis was more prevalent in non-HIV infected patients, while advanced fibrosis had a higher prevalence in people living with HIV. HIV infection was not found to be an independent risk factor for either hepatic steatosis or fibrosis.