Screening for non-alcoholic fatty liver disease (NAFLD) among PLWH should be expanded to include normal-weight PLWH with abnormal metabolism or elevated alanine aminotransferase (ALT), researchers suggested in Clinical Infectious Diseases.
Their study included 1,511 participants from three distinct cohorts focusing on liver disease among people with HIV, two of which took place in Italy and one of which took place in Canada. None of the participants were coinfected with hepatitis C.
In total, 57% of all participants were considered lean (i.e., not overweight or obese), and 24% of lean participants had NAFLD, for an overall prevalence of 14% for lean NAFLD. A higher proportion of lean participants with NAFLD had significant liver fibrosis – which can lead to liver cancer – than overweight/obese participants with NAFLD. Age, triglycerides, and ALT levels were associated with lean NAFLD.
Normal-weight people with this condition may have a different metabolism than their overweight peers or underreport their alcohol consumption, study authors hypothesized. Health care providers should therefore consider screening older PLWH with dyslipidemia and elevated ALT for fatty liver, even if they are not overweight or obese, they recommended.
Study authors also called for further research that includes specific antiretroviral treatment regimens, body fat distribution, and insulin markers, among other characteristics not available in this study.