Factors Associated With Liver Steatosis in People With Human Immunodeficiency Virus on Contemporary Antiretroviral Therapy.

Background: Given the impact of new antiretroviral drugs on weight and metabolic parameters, their potential contribution to the development of liver steatosis is of concern. We investigated the determinants of liver steatosis in patients on antiretroviral therapy (ART) in the Swiss HIV Cohort Study (SHCS).
Methods: Between 2019 and 2021, we measured liver stiffness and controlled attenuation parameter (CAP) using transient elastography in consecutive SHCS participants at Bern University Hospital. Individuals with viral hepatitis coinfection and pregnant women were excluded. We used multivariable logistic regression to explore factors associated with steatosis.
Results: Of 416 participants, 113 (27.2%) were female, median age was 51 years (interquartile range [IQR], 43-59), 305 (73.3%) were of European origin, and 212 (51.0%) were overweight/obese (body mass index [BMI] ≥25 kg/m ² ). Liver steatosis (CAP ≥248 dB/m) was present in 212 (51.0%) participants, 11 (5.2%) of whom had significant fibrosis or cirrhosis. One hundred seventy-nine (43.0%) met the criteria for metabolic-associated fatty liver disease (MAFLD). Among 64 individuals with a BMI <25 kg/m ² and liver steatosis, 31 (48.4%) had MAFLD. In multivariable analyses, BMI ≥25 kg/m ² (adjusted odds ratio, 5.76; 95% confidence interval, 3.57-9.29), age ≥50 years (1.88, 1.14-3.09), European origin (3.16, 1.69-5.89), and current use of tenofovir alafenamide (1.70, 1.08-2.69) were associated with liver steatosis. Exposure to integrase inhibitors was not associated with liver steatosis (0.83, 0.51-1.37).
Conclusions: Our findings suggest a high prevalence of liver steatosis among people with HIV (PWH) on ART in Switzerland. In addition to established risk factors, the use of tenofovir alafenamide was associated with hepatic steatosis.
Competing Interests: Potential conflicts of interest. G. W. reports support to his home institution for advisory boards and/or travel grants from MSD, Gilead Sciences and Abbvie, and unrestricted research grants from Gilead Sciences and Roche Diagnostics. B. S. reports support to his institution for advisory boards and travel grants from Gilead Sciences. H. F. G. has received unrestricted research grants from Gilead Sciences; fees for data and safety monitoring board membership from Merck; consulting/advisory board membership fees from Gilead Sciences, Merck, ViiV, Janssen and Novartis; and grants the Swiss National Science Foundation, National Institutes of Health, and the Yvonne Jacob Foundation. The institutions from which H. F. have received educational grants are as follows: Gilead, ViiV, MSD, Abbvie, and Sandoz. P. E. T.'s institution has received grants, advisory fees and/or educational fees from Gilead, Viiv, MSD, and Daiichi-Sankyo. C. R. is recipient of the Protected Research Time Grant for PhD students of the University of Bern. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. A. R. reports support to his home institution for advisory boards and/or travel grants from MSD, Gilead, Sciences and Pfizer, and unrestricted research grants from Gilead Sciences.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)