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Nonalcoholic Fatty Liver Disease Among HIV-Infected Persons

Crum-Cianflone, Nancy MD, MPH*†‡; Dilay, Angelica MPH; Collins, Gary MS§; Asher, Dean MD; Campin, Richard MD; Medina, Sheila BS*†; Goodman, Zach MD; Parker, Robin MD; Lifson, Alan PhD§; Capozza, Thomas MD#; Bavaro, Mary MD*; Hale, Braden MD, MPH*†; Hames, Charles MD#

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 2009 - Volume 50 - Issue 5 - p 464-473
doi: 10.1097/QAI.0b013e318198a88a
Clinical Science

Objective: To describe the prevalence and factors associated with nonalcoholic fatty liver disease (NAFLD) among HIV-infected persons not infected with hepatitis C virus (HCV).

Design: A cross-sectional study among HIV-infected patients in a large HIV clinic.

Methods: NAFLD was defined as steatosis among patients without viral hepatitis (B or C) coinfection or excessive alcohol use. The prevalence of NAFLD was identified by ultrasound examination evaluated by 2 radiologists blinded to the clinic information; liver biopsies were performed on a subset of the study population. Factors associated with NAFLD were evaluated by proportional odds logistic regression models.

Results: Sixty-seven of 216 patients (31%) had NAFLD based on ultrasound evaluation. Among those with NAFLD, steatosis was graded as mild in 60%, moderate in 28%, and severe/marked in 12%. Factors associated with the degree of steatosis on ultrasound examination in the multivariate model included increased waist circumference [odds ratio (OR) 2.1 per 10 cm, P < 0.001], elevated triglyceride levels (OR 1.2 per 100 mg/dL, P = 0.03), and lower high-density lipoprotein levels (OR 0.7, per 10 mg/dL, P = 0.03). African Americans were less likely to have NAFLD compared with whites (14% vs. 35%), although this did not reach statistical significance (OR 0.4, P = 0.08). Similar associations were noted for the subset of patients diagnosed by liver biopsy. CD4 cell count, HIV viral load, duration of HIV infection, and antiretroviral medications were not independent risk factors associated with NAFLD after adjustment for dyslipidemia or waist circumference.

Conclusions: NAFLD was common among this cohort of HIV-infected HCV-seronegative patients. NAFLD was associated with a greater waist circumference, low high-density lipoprotein, and high triglyceride levels. Antiretroviral medications were not associated with NAFLD; prospective studies are needed to confirm this finding.

From the *HIV Clinic, Naval Medical Center San Diego, San Diego, CA; †Infectious Disease Clinical Research Program (IDCRP), Bethesda, MD; ‡School of Public Health Department, San Diego State University, San Diego, CA; §Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN; ‖Radiology Department, Naval Medical Center San Diego, San Diego, CA; ¶Armed Forces Institute of Pathology, Washington, DC; and #Gastroenterology Department, Naval Medical Center San Diego, San Diego, CA.

Received for publication May 23, 2008; accepted November 26, 2008.

Supported by the Infectious Disease Clinical Research Program (IDCRP), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, of which the Tri-Service AIDS Clinical Consortium is a component. The IDCRP is a Department of Defense tri-service program executed through USUHS and the Henry M. Jackson Foundation for the Advancement of Military Medicine in collaboration with HHS/NIH/NIAID/DCR through Interagency Agreement HU0001-05-2-0011.

This work is original and has not been published elsewhere. Some data contained in this article were presented as abstract #822 at the 14th Conference on Retroviruses and Opportunistic Infections, February 25-28, 2007, Los Angeles, CA.

The opinions or ascertainments contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, or Air Force or the Department of Defense. The authors have no commercial or other association that might pose a conflict of interest in this work.

Correspondence to: Dr. Nancy Crum-Cianflone, MD, MPH, c/o Clinical Investigation Department (KCA), Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.