Fatty liver disease increases the risk of cardiovascular disease in people living with HIV

Non-alcoholic fatty liver disease (NAFLD) increases the risk of cardiovascular disease in people living with HIV, according to the results of a study published in HIV Medicine.

The accumulation of fat in the liver can lead to its damage (fibrosis). NAFLD is an asymptomatic disease that is most often associated with nutrition and is most common in Western countries. According to the data, the prevalence of NAFLD among people living with HIV is 35%. For comparison, among the population as a whole, this figure is 25%. Although fatty liver disease is often accompanied by obesity, one study showed that one in four people living with with HIV whose body weight was within normal range had NAFLD.

Research

Italian and Canadian researchers explored whether NAFLD contributes to the development of cardiovascular disease (CVD) among people living with HIV. Experts used data from patients from Palermo, Modena and Montreal. The participants were under 60 years of age with normal body weight.

The analysis did not include people with a high alcohol intake, people with viral hepatitis and other liver diseases. The average age of the participants was 54 years, 96% of them were taking antiretroviral therapy, and 78% had an undetectable viral load. 75% of the participants were male and 86% were white.

Results

Of the 941 participants living with HIV:

• 20% of the participants were diagnosed with fatty liver disease
• 17% had fibrosis
• 4% had cirrhosis

When it came to cardiovascular risk, using the 2018 American College of Cardiology guidelines ten-year cardiovascular risk scale:

• 13% were high risk
• 27% were intermediate risk
• 13% borderline risk
• 45% low risk

Participants with NAFLD and/or liver fibrosis were calculated to have a significantly higher risk of cardiovascular disease. The following factors were identified as factors contributing to the development of cardiovascular disease in people living with HIV:

• Fatty liver disease
• Body mass index of 25 or higher
• Time since HIV diagnosis
• Treatment with zidovudine, stavudine and/or didanosine

The study’s authors said “We found that the effect of NAFLD and liver fibrosis was more pronounced in lean and younger patients. Notably, NAFLD resulted in almost three times higher cardiovascular risk in lean patients.”

Conclusions

The research team believe that people living with HIV should undergo routine screening for NAFLD and cardiovascular disease, even if the patient is young and has a healthy BMI.