Incidence of liver damage of uncertain origin in HIV patients not co-infected with HCV/HBV.

BACKGROUND AND AIMS Several studies have reported that a significant number of HIV patients not co-infected with HCV/HBV develop liver damage of uncertain origin (LDUO). The objective of our study was to evaluate the incidence of and risk factors for the development of LDUO in HIV infected patients not co-infected with HCV/HBV. METHODS Prospective longitudinal study that included HIV-infected patients free of previous liver damage and viral hepatitis B or C co-infections. Patients were followed up at 6-monthly intervals. Liver stiffness was measured at each visit. Abnormal liver stiffness (ALS) was defined as a liver stiffness value greater than 7.2 kPa at two consecutive measurements. For patients who developed ALS, a protocol was followed to diagnose the cause of liver damage. Those patients who could not be diagnosed with any specific cause of liver disease were diagnosed as LDUO and liver biopsy was proposed. RESULTS 210 patients matched the inclusion criteria and were included. 198 patients completed the study. After a median (Q1-Q3) follow-up of 18 (IQR 12-26) months, 21 patients (10.6%) developed ALS. Of these, fifteen patients were diagnosed as LDUO. The incidence of LDUO was 7.64 cases/100 patient-years. Histological studies were performed on ten (66.6%) patients and all showed liver steatosis. A higher HOMA-IR value and body mass index were independently associated with the development of LDUO. CONCLUSION We found a high incidence of LDUO in HIV-infected patients associated with metabolic risk factors. The leading cause of LDUO in our study was non-alcoholic fatty liver disease.

Journal Article; Research Support, Non-U.S. Gov't;

This work was supported by Fundación Progreso y Salud, Consejería de Salud de la Junta de Andalucía (grants for health research projects: refs. PI: 0036/2010; PI-0247/2010; PI-0208/2008; PI-0124/2008; PI-0305/2009), Spanish Minister of Health ISCIII-RETIC RD06/006 projects PI-10/164, PI-509/0024 and PI-10/01232, Fundación para la Investigación y Prevención del SIDA en España (FIPSE-3536/05). J.A.P. has received a Research Extension Grant from the Programa de Intensificación de la Actividad de Investigación del Servicio Nacional de salud español (I3SNS). A.R. has received a Research Extension Grant from the Consejería de Salud, Innovación y Ciencia from the Junta de Andalucía. J.A.P. is the recipient of extension grant from the Instituto de Salud Carlos III (grant number Programa-I3SNS). J.M. has received the Reserach Grant Refuerzo con recursos humanos de la actividad investigadora de las Unidades de Gestion Clinica del SAS mediante contratos de larga duración, para el desarrollo de programas de investigación, desarrollo e innovación (Exp. B0037).