Objective:

To describe the prevalence and factors associated with nonalcoholic fatty liver disease (NAFLD) among HIV-infected persons not infected with hepatitis C virus (HCV).

Design:

A cross-sectional study among HIV-infected patients in a large HIV clinic.

Methods:

NAFLD was defined as steatosis among patients without viral hepatitis (B or C) coinfection or excessive alcohol use. The prevalence of NAFLD was identified by ultrasound examination evaluated by 2 radiologists blinded to the clinic information; liver biopsies were performed on a subset of the study population. Factors associated with NAFLD were evaluated by proportional odds logistic regression models.

Results:

Sixty-seven of 216 patients (31%) had NAFLD based on ultrasound evaluation. Among those with NAFLD, steatosis was graded as mild in 60%, moderate in 28%, and severe/marked in 12%. Factors associated with the degree of steatosis on ultrasound examination in the multivariate model included increased waist circumference [odds ratio (OR) 2.1 per 10 cm, P< 0.001], elevated triglyceride levels (OR 1.2 per 100 mg/dL, P= 0.03), and lower high-density lipoprotein levels (OR 0.7, per 10 mg/dL, P= 0.03). African Americans were less likely to have NAFLD compared with whites (14% vs. 35%), although this did not reach statistical significance (OR 0.4, P= 0.08). Similar associations were noted for the subset of patients diagnosed by liver biopsy. CD4 cell count, HIV viral load, duration of HIV infection, and antiretroviral medications were not independent risk factors associated with NAFLD after adjustment for dyslipidemia or waist circumference.

Conclusions:

NAFLD was common among this cohort of HIV-infected HCV-seronegative patients. NAFLD was associated with a greater waist circumference, low high-density lipoprotein, and high triglyceride levels. Antiretroviral medications were not associated with NAFLD; prospective studies are needed to confirm this finding.

BACKGROUND

As HIV-infected persons are experiencing longer life expectancies, 1 other causes of morbidity and mortality among this group are increasingly being recognized. Recently, liver disease was identified as a leading cause of death among HIV-infected persons. 2, 3 Patients with HIV infection frequently have elevated liver function tests (LFTs), 4 which are often attributed to viral hepatitis (B and C) coinfections or antiretroviral medication effects. The epidemiology of nonalcoholic fatty liver disease (NAFLD) has not been studied among patients with HIV without concurrent hepatitis C virus (HCV) infection but may be an important cause of liver disease in this population.