Factors Associated With Liver Steatosis in People With Human Immunodeficiency Virus on Contemporary Antiretroviral Therapy

Carlotta Riebensahm; Annalisa Berzigotti; Bernard Surial; Huldrych F Günthard; Philip E Tarr; Hansjakob Furrer; Andri Rauch; Gilles Wandeler; Swiss HIV Cohort Study

doi:10.1093/ofid/ofac538

Factors Associated With Liver Steatosis in People With Human Immunodeficiency Virus on Contemporary Antiretroviral Therapy

Open Forum Infect Dis. 2022 Oct 14;9(11):ofac538. doi: 10.1093/ofid/ofac538. eCollection 2022 Nov.

Authors

Carlotta Riebensahm^{1

2}, Annalisa Berzigotti^{3

4}, Bernard Surial¹, Huldrych F Günthard^{5

6}, Philip E Tarr⁷, Hansjakob Furrer¹, Andri Rauch¹, Gilles Wandeler^{1

8}; Swiss HIV Cohort Study

Affiliations

¹ Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Graduate School of Health Sciences, University of Bern, Bern, Switzerland.
³ Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Hepatology, Department of BioMedical Research, University of Bern, Bern, Switzerland.
⁵ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶ Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
⁷ University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.
⁸ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Abstract

Background: Given the impact of new antiretroviral drugs on weight and metabolic parameters, their potential contribution to the development of liver steatosis is of concern. We investigated the determinants of liver steatosis in patients on antiretroviral therapy (ART) in the Swiss HIV Cohort Study (SHCS).

Methods: Between 2019 and 2021, we measured liver stiffness and controlled attenuation parameter (CAP) using transient elastography in consecutive SHCS participants at Bern University Hospital. Individuals with viral hepatitis coinfection and pregnant women were excluded. We used multivariable logistic regression to explore factors associated with steatosis.

Results: Of 416 participants, 113 (27.2%) were female, median age was 51 years (interquartile range [IQR], 43-59), 305 (73.3%) were of European origin, and 212 (51.0%) were overweight/obese (body mass index [BMI] ≥25 kg/m²). Liver steatosis (CAP ≥248 dB/m) was present in 212 (51.0%) participants, 11 (5.2%) of whom had significant fibrosis or cirrhosis. One hundred seventy-nine (43.0%) met the criteria for metabolic-associated fatty liver disease (MAFLD). Among 64 individuals with a BMI <25 kg/m² and liver steatosis, 31 (48.4%) had MAFLD. In multivariable analyses, BMI ≥25 kg/m² (adjusted odds ratio, 5.76; 95% confidence interval, 3.57-9.29), age ≥50 years (1.88, 1.14-3.09), European origin (3.16, 1.69-5.89), and current use of tenofovir alafenamide (1.70, 1.08-2.69) were associated with liver steatosis. Exposure to integrase inhibitors was not associated with liver steatosis (0.83, 0.51-1.37).

Conclusions: Our findings suggest a high prevalence of liver steatosis among people with HIV (PWH) on ART in Switzerland. In addition to established risk factors, the use of tenofovir alafenamide was associated with hepatic steatosis.

Keywords: antiretroviral therapy; liver steatosis; metabolic comorbidities; metabolic-associated fatty liver disease; people with HIV.

Grants and funding

177499/SNSF_/Swiss National Science Foundation/Switzerland