Increased prevalence of liver fibrosis in people living with HIV without viral hepatitis compared to population controls

BACKGROUND: Liver fibrosis is associated with poor liver related outcomes and mortality. People living with HIV (PWH) may be at increased risk. We aimed to estimate the prevalence and factors associated with liver fibrosis in PWH compared to population controls.

METHODS: Cross-sectional cohort study. We compared 342 PWH with 2,190 population controls aged 50-70 years. Transient elastography was performed and elevated liver stiffness measurement (LSM) defined as 7.6kPa as a proxy for significant liver fibrosis. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were computed by logistic regression.

RESULTS: The prevalence of elevated LSM was higher in PWH than in uninfected controls (12% vs 7%), p<0.01). HIV infection was independently associated with elevated LSM. In multivariate analysis, elevated LSM was associated with HIV (aOR:1.84 (1.17;2.88), p<0.01); higher age (per decade, aOR:3.34 (1.81;6.18), p<0.01); ALT (per 10 IU/L, aOR:1.25 (1.05;1.49), p<0.01); BMI (per 1 kg/m 2, aOR:1.17 (1.05;1.29), p<0.01) and previous exposure to didanosine (per year aOR:2.26 (1,01;5.06), p=0.05).

CONCLUSIONS: The prevalence of elevated LSM was higher in PWH compared to population controls. Higher age, BMI, ALT, previous exposure to didanosine and a positive HIV status was independently associated with higher odds of elevated LSM.