Incident liver cirrhosis, associated factors and cardiovascular disease risks among people living with HIV: a longitudinal study.

OBJECTIVES We investigated the incidence and associated factors of liver cirrhosis, and cardiovascular disease risks among people living with HIV (PLHIV) in a Thai cohort. DESIGN A prospective cohort analysis. METHODS Participants with at least one reliable transient elastography (TE) measurement during follow-up, who had pre-treatment ALT, AST and platelet count at HIV treatment initiation were included. Liver cirrhosis was defined as AST to Platelet Ratio Index (APRI) >1.5 or fibrosis-4 (FIB-4) >3.25 or liver stiffness by TE >12.5 kPa, and confirmed by imaging or liver biopsy. Competing-risk regression was used to identify factors associated with liver cirrhosis. Time-updated 10-year atherosclerotic cardiovascular disease (ASCVD) risks were compared between PLHIV with or without liver cirrhosis. RESULTS A total of 1,069 participants (33% female, 9% HCV, 16% HBV) with median age and CD4 at cART initiation of 32 years and 240 cells/mm were included. During 8232 person-years (PYS), 124 (12%) developed liver cirrhosis after a median of 6.9 (2.4-13.7) follow-up years (incidence, 1.5 [95%CI, 1.3-1.8] per 100 PYS). In multivariable analysis, the factors independently associated with liver cirrhosis were time-updated HIV viremia, HBV and HCV co-infection, diabetes mellitus, HDL <40 mg/mL, and d4T exposure. Median time-updated 10-year ASCVD risk score was statistically higher among cirrhotic PLHIV vs. non-cirrhosis (4.9% [IQR, 2.3-9.7] vs. 2.4% [IQR, 1.3-4.9], p<0.001). CONCLUSION PLHIV with metabolic diseases were more likely to develop liver cirrhosis, independent of hepatitis co-infections, and ASCVD risks were higher among cirrhotic individuals.