Non-alcoholic fatty liver disease (FLD) is common among people coinfected with HIV and HBV, even if both viruses are under control, a study published in Clinical Infectious Diseases found.
Researchers performed liver biopsies on 114 HIV/HBV coinfected people, 93% of whom were male and 51% of whom were Black. HIV was controlled in 93% of participants (HIV RNA < 400 copies/mL) and HBV in 83% (HBV DNA < 1000 IU/mL). Thirty percent showed fatty liver disease (20% of participants steatosis, 10% steatohepatitis), but there were wide variations by race: FLD was present among 46% of white participants, compared to 16% of Black participants.
Risk factors among PLWH were similar to those among HIV-negative people. Traditional lipid values were no different between participants with and without fatty liver, but atherogenic lipid subfractions were higher in the FLD group.
Subfraction trends also correlated with increased triglycerides, suggesting that triglyceride trends could be used as a proxy for atherogenic lipids, which serve as an indicator of cardiovascular risk.
Persistently elevated alanine aminotransferase values were also associated with FLD, even with HBV under control, suggesting that if such values are discovered in a patient, they may warrant evaluation for fatty liver disease, study authors recommended. They noted that they plan to assess the follow-up histology among participants.
A related commentary by Tinsay A. Woreta, M.D., M.P.H., of the Johns Hopkins School of Medicine, and Naga Chalasani, M.D., of the Indiana University School of Medicine, noted that much still needs to be learned about the interplay between HBV, HIV, and liver disease in the wake of this study—including an answer to the question of why FLD was less prevalent among Black participants. They called for additional research, including longitudinal studies with paired liver biopsies.