Stratifying the risk of NAFLD in patients with HIV under combination antiretroviral therapy (cART)
| العنوان: | Stratifying the risk of NAFLD in patients with HIV under combination antiretroviral therapy (cART) |
|---|---|
| المؤلفون: | Kathrin van Bremen, Christoph Boesecke, Jenny Bischoff, Carolynne Schwarze-Zander, Wenyi Gu, Jan-Christian Wasmuth, Jonel Trebicka, Leona Dold, Jürgen K. Rockstroh |
| المصدر: | EClinicalMedicine, Vol 40, Iss, Pp 101116-(2021) EClinicalMedicine E Clinical Medicine part of the LANCET Discovery Science |
| بيانات النشر: | Elsevier BV, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Medicine (General), medicine.medical_specialty, Steatosis, TAF, tenofovir-alafenamid, BMI, body mass index, NASH, non-alcoholic steatohepatitis, FIB4, fibrosis-4, cART, AST, aspartate aminotransferase, APRI, AST to platelet ratio index, INSTI, integrase strand transfer inhibitors, TDF, Tenofovir disoproxilfumarate, Lower risk, PrEP, pre-exposure prophylaxis, Pre-exposure prophylaxis, R5-920, Internal medicine, medicine, PLHIV, people living with HIV, FAST, FibroScan-AST, Nafld, business.industry, Proportional hazards model, Fatty liver, Hiv, DAA, direct-acting antiviral, NAFLD, Non-alcoholic fatty liver disease, General Medicine, medicine.disease, Cap, Comorbidity, TE, transient elastography, CAP, controlled attenuation parameter, HCV, chronic hepatitis C, Transient elastography, business, Body mass index, ART, antiretroviral treatment, Research Paper |
| الوصف: | Background: De novo steatosis is the main criteria for non-alcoholic fatty liver disease (NAFLD), which is becoming a clinically relevant comorbidity in HIV-infected patients. This may be due to the HIV virus itself, as well as long-term toxicities deriving from antiretroviral therapy. Therefore, HIV infected patients require prevention and monitoring regarding NAFLD. Methods: This study investigated the differential role of body mass index (BMI) and combination antiretroviral treatment (cART) drugs on NAFLD progression. This single center prospective longitudinal observational study enrolled HIV monoinfected individuals between August 2013 to December 2018 with yearly visits. Each visit included liver stiffness and steatosis [defined as controlled attenuation parameter (CAP)>237 dB/m] assessment by annually transient elastography using an M- or XL-probe of FibroScan, and calculation of the novel FibroScan-AST (FAST) score. Risk factors for denovo/progressed steatosis and tripling of FAST-score increase were investigated using Cox regression model with time-dependent covariates. Findings: 319 monoinfected HIV positive patients with at least two visits were included into the study, of which 301 patients had at least two valid CAP measurements. 51·5%(155) patients did not have steatosis at first assessment, of which 45%(69) developed steatosis during follow-up. A BMI>23 kg/m2 (OR: 4·238, 95% CI: 2·078–8·938; p < 0·0001), tenofovir-alafenamid (TAF) (OR: 5·073, 95% CI: 2·362–10·899); p < 0·0001) and integrase strand transfer inhibitors (INSTI) (OR: 2·354, 95% CI: 1·370–4·048; p = 0·002), as well as type 2 diabetes mellitus (OR: 7·605, 95% CI: 2·315–24·981; p < 0·0001) were independent predictors of de novo steatosis in multivariable analysis. Tenofovir disoproxilfumarate (TDF) was associated with a lower risk for weight gain and steatosis progression/onset using CAP value (HR: 0·28, 95% CI: 0·12–0·64; p = 0·003) and FAST scores (HR: 0·31, 95% CI: 0·101–0·945; p = 0·04). Interpretation: Steatosis can develop despite non-obese BMI in patients with HIV monoinfection under cART, especially in male patients with BMI over 23 kg/m2. While TAF and INSTI increase the risk of progression of steatosis, TDF was found to be independently associated with a lower risk of a clinically significant weight gain and thereby, might slow down development and progression of steatosis. Funding: There was no additional funding received for this project. All funders mentioned in the ‘declaration of interests’ section had no influence on study design, data collection and analysis, decision to publish, or preparation of the manuscript. |
| تدمد: | 2589-5370 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f4c309e13de16a72b2c91a8b35344a42Test https://doi.org/10.1016/j.eclinm.2021.101116Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....f4c309e13de16a72b2c91a8b35344a42 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 25895370 |
|---|