Prevalence and risk factors of non-alcoholic fatty liver disease in HIV-monoinfection: A systematic review and meta-analysis


OBJECTIVE: to identify the prevalence and risk factors of NAFLD, NASH and fibrosis in HIV-monoinfected patients. DESIGN: Systematic review and meta-analysis. METHODS: We searched Medline and Embase and included studies that enrolled HIV-monoinfected patients with NAFLD defined by imaging and/or liver histology. Data on prevalence and risk factors for NAFLD, NASH and fibrosis were collected for meta-analysis using random effects models. RESULTS: Ten studies were included from USA (n = 4), Canada (n = 1), France (n = 2), Italy (n = 1), Japan (n = 1) and China (n = 1). The prevalence of NAFLD (Imaging studies), NASH and fibrosis (biopsied populations) were 35% (95% CI 29-42), 42% (95% CI 22-64) and 22% (95% CI 13-34), respectively. Meta-analysis of risk factors showed high BMI, waist circumference, type 2 diabetes, hypertension, triglycerides and high CD4 cell count were associated with NAFLD, whereas HIV viral load, duration of HIV infection, duration of ART and CD4 nadir were not. Patients with high BMI (MD 1.38 95% CI 0.04-2.71 p = 0.04), fasting glucose (MD 0.80 95% CI 0.47-1.13 p < 0.00001) and AST level (MD 13.00 95% CI 4.34-21.65 p = 0.003) were at increased risk of significant liver fibrosis. CONCLUSIONS: NAFLD isfrequently observed in HIV-monoinfected patients, and NASH is a common cause of unexplained abnormal liver function in patients selected for liver biopsy. Metabolic disorders are key risk factors independently of HIV parameters. Future trials on pharmacological interventions in NASH with fibrosis should include patients with HIV


Maurice JB, Patel A, Scott AJ, Patel K, Thursz M, Lemoine M




  • Epidemiology and Determinants of Health
    • Epidemiology
  • Population(s)
    • General HIV+ population
  • Co-morbidities
    • Other


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