The increasing burden and risk of non-alcoholic fatty liver disease (NAFLD) associated with HIV infection have today been highlighted in two studies presented at The International Liver Congress 2019 in Vienna, Austria. These studies found that, whilst prevalence and mortality rates associated with viral hepatitis in HIV-infected individuals have been declining, rates associated with NAFLD are increasing, leading to a risk of progressive liver disease.
People living with HIV infection appear to be at greater risk of developing NAFLD than the general population. The prevalence of NAFLD worldwide has been estimated to be 25%, while the prevalence in populations with HIV has been far higher in most reported studies. NAFLD represents an important risk factor for the development and progression of liver disease,5 and with the availability of effective hepatitis B and C antiviral medications, it is conceivable that NAFLD could become the most prominent liver disease affecting individuals with HIV in the future.
The first study presented in Vienna aimed to assess the prevalence and mortality trends of NAFLD, viral hepatitis, and other liver diseases in HIV-infected individuals. The records of >47,000 HIV-infected Medicare recipients in the USA were searched, and >10,000 individuals with liver disease were identified: 5,628 with HCV-related disease, 1,374 with HBV-related disease, 645 with HCV/HBV-related disease, 2,629 with NAFLD, and 198 with other liver diseases. During the 10 years between 2006 and 2016, the prevalence rates for viral hepatitis decreased from 27.75 to 24.17 per 100,000 population (p=0.009) whilst the rates for NAFLD more than doubled from 5.32 to 11.62 per 100,000 population (p<0.001). Mortality rates related to viral hepatitis also decreased from 3.78 to 2.58 per 100,000 population (p=0.006), whilst mortality related to NAFLD increased from 0.18 to 0.80 per 100,000 population (p=0.041).
'Our study shows that, as highly effective treatments for HBV and HCV infections lead to reduced associated mortality in HIV-infected populations, NAFLD is becoming an increasingly important cause of liver disease,' said Dr. Zobair Younossi, Professor and Chairman of the Department of Medicine at Inova Fairfax Medical Campus in Falls Church, Virginia, USA, who presented the study results.
The second study, involving teams from Canada, the UK and Italy, used a diagnostic algorithm based on current EASL guidelines in HIV-negative populations6 to identify individuals with NAFLD from two cohorts of adults with living with HIV without significant alcohol intake or viral hepatitis coinfection (the LIVEr disease in HIV [LIVEHIV] and Modena HIV Metabolic Clinic [MHMC] cohorts). Of the 1,228 HIV-infected individuals reviewed (mean age 50 years; 73% males; time since diagnosis 16 years), 31.8% had NAFLD. Based on elevated alanine aminotransferase (ALT) levels and/or significant fibrosis, 25.2% of these patients were considered to be at risk of progressive liver disease compared with 18.4% of patients without NAFLD. Independent predictors of liver disease progression requiring specialist referral were found to be male sex, diabetes, and duration of HIV infection.
'Applying current NAFLD guidelines developed for HIV-negative populations, we have identified significant proportions of patients with HIV infection at risk of NAFLD and progressive liver disease,' said Dr. Sila Cocciolillo from the Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada. 'We think this supports the need for dedicated monitoring of these patients, with referral to hepatology services when required.'
Professor Philip Newsome (Vice-Secretary, EASL) said, "These studies indicate the changing profile of liver disease in patients with HIV—whilst viral hepatitis is still the major cause of liver disease in such groups, NAFLD is becoming a much commoner problem. This reinforces the need to study of therapeutic agents in patients with NAFLD and HIV, an area which is seldom examined."
Session title: 'NAFLD - Clinical burden natural history'
Time, date and location of session: 17:15-17:30, 11 April 2019, Strauss 1-2
Presenter: Zobair Younossi, USA
Abstract: The increasing importance of non-alcoholic fatty liver disease in human deficiency virus (HIV) positive patients (PS-062)
Session title: 'NAFLD: Diagnostics and non-invasive assessment'
Time, date and location of session: 09:00-17:00, 13 April 2019, Poster Area
Presenter: Sila Cocciolillo, Canada
Abstract: Application of guidelines for fatty liver in two prospective cohorts of human immunodeficiency virus positive patients (SAT-286)
Provided by The European Association for the Study of the Liver