Abstract
Whether HIV infection increases the risk of nonalcoholic steatohepatitis (NASH) remains unclear. We evaluated the association of HIV with elevated FibroScan-AST (FAST) score, a noninvasive surrogate for NASH with high nonalcoholic fatty liver disease activity score and significant liver fibrosis.
Background Whether human immunodeficiency virus (HIV) infection is associated with the development of nonalcoholic steatohepatitis (NASH) remains unclear. The FibroScan-aspartate aminotransferase (FAST) score was developed to identify patients who have histologic NASH with high nonalcoholic fatty liver disease activity score (NAS >= 4) and significant liver fibrosis (>= F2), which has been associated with higher risk of end-stage liver disease. We examined whether HIV infection is associated with elevated FAST score in a large United States (US) cohort. Methods Vibration-controlled transient elastography was performed in 1309 women without history of chronic viral hepatitis enrolled from 10 US sites: 928 women living with HIV (WLWH) and 381 women living without HIV (WLWOH). We used multivariable logistic regression to evaluate associations of HIV, demographic, lifestyle, and metabolic factors with an elevated (>0.35) FAST score. Results Median age of WLWH and WLWOH was 51 years and 48 years, respectively. Most (90%) WLWH were on antiretroviral therapy and 72% had undetectable HIV RNA. Prevalence of elevated FAST score was higher among WLWH compared to WLWOH (6.3% vs 1.8%, respectively; P = .001). On multivariable analysis, HIV infection was associated with 3.7-fold higher odds of elevated FAST score (P = .002), and greater waist circumference (per 10 cm) was associated with 1.7-fold higher odds (P < .001). In analysis limited to WLWH, undetectable HIV RNA and current protease inhibitor use were independently associated with lower odds of elevated FAST score. Conclusions Our findings suggest that HIV is an independent risk factor for NASH with significant activity and fibrosis. Studies validating FAST score in persons living with HIV are warranted.
