Prevalence, predictors and severity of lean non-alcoholic fatty liver disease in HIV-infected patients.

BACKGROUND: The burden of non-alcoholic fatty liver disease (NAFLD) is growing in people with HIV. NAFLD is associated with obesity, however it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in HIV-infected patients. METHODS: We included HIV mono-infected patients from three prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter >/=248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when BMI /=7.1 kPa. Presence of any among diabetes, hypertension or hyperlipidemia defined metabolic abnormal patients. RESULTS: 1511 patients were included, of whom 57.4% were lean. Prevalence of lean NAFLD in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportion of lean NAFLD patients who were metabolic abnormal or had elevated alanine aminotransferase (ALT) was higher than lean without NAFLD (61.9% vs. 48.9%; and 36.7% vs. 24.2%, respectively). Lean NAFLD patients had higher prevalence of significant liver fibrosis than lean without NAFLD (15.7% vs. 7.6%). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200mu/L and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR] 1.29, 95% confidence interval [CI] 1.04-1.59), high triglycerides (aOR 1.34, 95% CI 1.11-1.63) and high ALT (aOR 1.15, 95% CI 1.05-1.26), while high HDL was protective (aOR 0.45, 95% CI 0.26-0.77). CONCLUSION: NAFLD affects one in four lean HIV mono-infected patients. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT even if normoweight.