Background: Several studies have been reporting the burden of metabolic liver disease in HIV-infected individuals. However, the impact of HIV infection on prevalence of liver steatosis and associated risk factors still lack. We aimed to evaluate the prevalence and factors associated with liver steatosis in HIV mono-infected patients compared to uninfected subjects paired for confounding factors.
Methods: 649 HIV mono-infected patients from the INI-ELSA cohort were eligible. To test the association of HIV infection with steatosis, non-infected subjects from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (n=15,087) were paired by demographic, metabolic and inflammatory characteristics. Nearest neighbor matching with a 0.05 caliper on logistic regression-based scores were used for matching and balance was checked with usual procedures. The variables used for the matching and the ones used in the final model for risk factors for steatosis in HIV-infected individuals were selected through a genetic algorithm that searched for the best model fit. Fatty Liver Index (FLI) was calculated as previously validated [Bedogni BMC-Gastroenterology 2006] and liver steatosis was defined as FLI ≥ 60. Logistic regression analysis was performed to assess risk of steatosis in HIV-patients compared to controls and to identify factors associated with fatty liver in HIV-infected individuals.
Results: HIV-patients [58% male; median (IQR) age=44 (36-51) years; body mass index (BMI)=24.4 (21.9-27.5) Kg/m2; 33% with metabolic syndrome] were paired with 333 uninfected controls, with good balance on demographic and clinical characteristics between patients and controls. HIV infection was an independent factor associated with liver steatosis [OR=2.1 (95%CI 1.49-2.95), p< 0.001]. In a multivariate analysis with all HIV patients included, the following variables were independently associated [OR (95%CI)] with presence of steatosis: male gender [5.36 (2.41-11.94)]; Black/Pardo ethnicity [0.22 (0.09-0.55)]; hypertension [2.56 (1.25-5.26)]; diabetes [5.79 (2.58-13)]; dyslipidemia [2.57 (1.27-5.21)]; BMI [1.91 (1.67-2.18)]; CD4 count [per cell/mm3, 1.13 (1.01-1.27)] and cumulative HIV viral load [1.25 (1.02-1.54)].
Conclusions: HIV-infected individuals had 2-fold higher odds for presence of steatosis compared to uninfected paired controls. Traditional and HIV-specific risk factors were also associated with steatosis. Prevention of metabolic factors should be integrated to HIV care to decrease the burden of liver diseases in HIV-infected individuals.

HIV mono-infected (n= 649)OR (95%CI)p-value
Male gender (yes vs no)5.36 (2.41-11.94)< 0.001
Black/Pardo ethnicity (yes vs no)0.22 (0.09-0.55)0.001
Hypertension (yes vs no)2.56 (1.25-5.26)0.010
Type 2 diabetes (yes vs no)5.79 (2.58-13)< 0.001
Dyslipidemia (yes vs no)2.57 (1.27-5.21)0.009
BMI (kg/m2)1.91 (1.67-2.18)< 0.001
Poor health management (yes vs no)0.36 (0.17-0.79)0.011
CD4 count (per 100 cells/mm3)1.13 (1.01-1.27)0.036
Cumulative HIV viral load [per 10 log(copies/mm3)*year]1.25 (1.02-1.54)0.031
[Risk factors associated with liver steatosis in HIV mono-infected patients]