In high-income countries, liver disease represents a growing cause of morbidity and mortality among people living with HIV (PLHIV), and is linked to an increased burden of metabolic disorders. Little is known about the contribution of non-communicable diseases to the burden of liver disease in low and middle-income countries (LMIC).
We conducted a cross-sectional analysis of data collected between June 2015 and August 2021 from two ongoing cohorts: IeDEA-Sentinel Research Network and PROSPEC, which include PLHIV ?40 years on antiretroviral treatment for ?6 months in Brazil, Côte d’Ivoire, India, Kenya, Rwanda and Zambia. Patients were screened for hepatitis B and C virus infections (HBsAg, HCV Ab/RNA), obesity, dyslipidemia, hypertension, and diabetes. Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Transient elastography for Liver Stiffness Measurement (LSM)/Controlled Attenuation Parameter (CAP) was performed. Liver fibrosis and steatosis were defined as LSM >7.0 kPa and CAP ?248 dB/m, respectively. Factors associated with liver fibrosis and steatosis were assessed using multivariate logistic regression models. Population Attributable Fraction (PAF) for liver fibrosis was estimated using Levin’s formula.
In total, 1,632 PLHIV (58.9% female, median age 50 (interquartile range: 45-52) years) were included in the analysis. Patients were reported to have obesity (19.5%), diabetes (11.3%), hypertension (24.9%), dyslipidemia (53.9%), hepatitis B (4.5%) and C (3.4%). Among PLHIV co-infected with hepatitis B, 67.6% were currently on tenofovir. Hazardous alcohol use (AUDIT score ?8) was found in 246 (15.1%) patients. LSM and CAP were deemed reliable in 91% (n=1492) and 78% (n=1279) of measurements, respectively. The prevalence of liver fibrosis was 11.7% (95% confidence interval (CI) 10.0-13.9), and 31.3% (CI 28.7-33.8) had steatosis. Hepatitis, male sex, obesity, diabetes and CD4 count <200 cells/mm3 were independently associated with liver fibrosis (see table). Factors associated with steatosis included obesity (OR 5.29, CI 3.46-8.08) and diabetes (OR 2.42, CI 1.58-3.69).
Metabolic disorders contributed to a higher proportion of liver fibrosis than chronic viral hepatitis among PLHIV in this LMIC cohort. As access to effective antiviral therapies against chronic viral hepatitis expands, preventive measures against diabetes and obesity in PLHIV are urgently needed.