Assessment of the Association of HIV Infection with Hepatic Steatosis or Fibrosis: a Cross-Sectional, Case-Control Study

Human immunodeficiency virus (HIV) infection and antiretroviral therapy have been associated with non-alcoholic fatty liver disease (NAFLD), but few studies have evaluated whether HIV infection is an independent risk factor for the development of hepatic steatosis and advanced liver fibrosis. To study the prevalence and severity of hepatic steatosis and advanced fibrosis in people living with HIV and control outpatients. We conducted a cross-sectional analysis of relevant data from 875 pairs of individuals belonging to an HIV-dedicated outpatient clinic and an adult primary care clinic of an inner-city hospital. Hepatic Steatosis Index (HSI) and FIB-4 index were calculated as non-invasive measures of steatosis and fibrosis, respectively. A multivariate logistic regression analysis was performed to assess predictors of steatosis and advanced fibrosis. The prevalence of hepatic steatosis, determined by HSI ≥ 36, was higher in HIV-negative subjects (71.5% vs. 65.4%, p = 0.006). The prevalence of advanced fibrosis, determined by FIB-4 index ≥ 3.25, was higher in the HIV-positive group (7% vs. 1.7%, p < 0.001). Multivariable analysis did not identify HIV infection to be an independent risk factor for hepatic steatosis (p = 0.068) and advanced fibrosis. In this cohort, hepatic steatosis was more prevalent in non-HIV infected patients, while advanced fibrosis had a higher prevalence in people living with HIV. HIV infection was not found to be an independent risk factor for either hepatic steatosis or fibrosis.