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Prevalence and factors associated with liver steatosis as measured by transient elastography with controlled attenuation parameter in HIV-infected patients

Macías, Juana; González, Juanb; Tural, Cristinac; Ortega-González, Enriqued; Pulido, Federicoe; Rubio, Rafaele; Cifuentes, Celiaa; Díaz-Menéndez, Martab; Jou, Antonic; Rubio, Purificaciónd; Burgos, Ángelf; Pineda, Juan A.a

doi: 10.1097/QAD.0000000000000248
Clinical Science

Objective: To assess the prevalence and factors associated with significant hepatic steatosis (SHS, steatosis involving ≥10% hepatocytes) in HIV-infected patients.

Design: A prospective, cross-sectional study.

Methods: Five hundred and five HIV-infected patients were included in this study. All patients underwent a transient elastography examination with the controlled attenuation parameter (CAP). SHS was defined using the previously identified CAP cut-off of 238 dB/m. We analysed the associations between SHS and demographics, metabolic data, coinfections and drug therapy.

Results: SHS was detected in 201 (40%) patients. Individuals with and without plasma HIV RNA of 50 copies/ml or less presented SHS in 168 (42%) and 33 (31%) cases, respectively (P = 0.030). Patients with SHS compared with those without SHS presented higher median (IQR) BMI [BMI, 25.6 (22.5–28) vs. 22.3 (20.3–24.2) kg/m2; P < 10–6], DBP [79 (72–85) vs. 74 (68–81) mmHg; P = 0.0001], fasting plasma glucose [95 (87–106) vs. 91 (84–97) mg/dl; P = 0.002] and triglycerides [128 (92–189) vs. 109 (80–167) mg/dl; P = 0.002], and lower HDL cholesterol [44 (37–54) vs. 48 (40–59), mg/dl; P = 0.004]. In multivariate analysis, the only factor associated with SHS was BMI [per unit increase, adjusted odds ratio (95% confidence interval) 1.34 (1.22–1–47); P < 10–6].

Conclusion: SHS measured by CAP is highly prevalent among HIV-infected patients. High BMI is the main predictor of SHS in this setting.

aHospital Universitario de Valme, Seville

bHospital Universitario La Paz, Madrid

cHospital Universitario Germans Trias i Pujol, Badalona

dHospital General Universitario de Valencia, Valencia

eHospital Universitario 12 de Octubre

fAbbVie, S.L.U, Madrid, Spain.

Correspondence to Dr Juan A. Pineda, Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda. Bellavista s/n, 41014 Seville, Spain. Tel: +34 955015684; e-mail:

Received 19 November, 2013

Revised 3 February, 2014

Accepted 3 February, 2014

© 2014 Lippincott Williams & Wilkins, Inc.