Non-alcoholic fatty liver disease (NAFLD) is a common problem in persons with HIV (PWH). NAFLD is associated elevated cardiovascular disease (CVD) risk. We present baseline data on the prevalence and cardiometabolic characteristics of NAFLD among REPRIEVE participants who underwent Computed Tomography (CT).
The REPRIEVE Mechanistic substudy is embedded within an international primary CVD prevention RCT of pitavastatin calcium vs. placebo among 7,770 PWH ages 40-75 years on antiretroviral therapy (ART). A subset of 655 U.S. participants had non-contrast CT with measurement of hepatic steatosis defined as a mean hepatic attenuation <40 HU or liver/spleen ratio <1.0. NAFLD was defined as steatosis in the absence of frequent alcohol use. The prevalence of NAFLD was compared by demographic, cardiometabolic and HIV-specific parameters. Distributions of immune activation/inflammatory indices data were compared among those with or without NAFLD. Analyses used log binomial regression and Wilcoxon tests.
Among 655 PWH: median age was 51 years, 17% natal female sex, 44% black race, median BMI 27 kg/m2, median CD4 count 606 c/mm3 and 98% with HIV VL <400 copies/mL. NAFLD prevalence was 20% (97/477 without frequent alcohol use). ALT was abnormally ? in those with NAFLD (45% vs. 25%, P<0.001). NAFLD was more prevalent with male sex, older age, non-black race (Figure). ASCVD risk score was higher in those with NAFLD (median 5.8% vs. 4.3%, P=0.002). Obesity, metabolic syndrome, elevated waist circumference, reduced HDL and elevated triglycerides, were all associated with NAFLD in unadjusted analyses (P<0.005); these effects were explained by obesity, metabolic syndrome and elevated HOMA-IR (Figure). NAFLD was associated with higher levels of LpPLA-2 (144 vs. 130 ng/ml, P=0.013) and hsCRP (2.2 vs. 1.6 mg/L, P=0.013). HIV-specific characteristics, ART and other circulating markers of immune activation/inflammation (IL-6, sCD163, MCP-1, sCD14 and D-dimer) were not associated with NAFLD.
In this cohort with controlled HIV, high CD4 counts, and low to moderate cardiovascular risk, NAFLD (20%) was common including 45% with clinically relevant ? in ALT. NAFLD was associated with select indices of inflammation and metabolic disturbances but not HIV or ART. NAFLD was more prevalent with male sex, older age, non-black race, elevated BMI and metabolic syndrome. Elevated LpPLA-2 and hsCRP levels suggest a correlation between NAFLD and cardiovascular risk in PWH.