Human Immunodeficiency Virus Is Associated With Elevated FibroScan-Aspartate Aminotransferase (FAST) Score - PubMed (original) (raw)

. 2022 Dec 19;75(12):2119-2127.

doi: 10.1093/cid/ciac337.

Yifei Ma 1, Mark H Kuniholm 2, Adaora A Adimora 3, Margaret Fischl 4, Audrey L French 5, Elizabeth T Golub 6, Deborah Konkle-Parker 7, Howard Minkoff 8, Ighovwerha Ofotokun 9, Michael Plankey 10, Anjali Sharma 11, Phyllis C Tien 1 12

Affiliations

Human Immunodeficiency Virus Is Associated With Elevated FibroScan-Aspartate Aminotransferase (FAST) Score

Jennifer C Price et al. Clin Infect Dis. 2022.

Abstract

Background: Whether human immunodeficiency virus (HIV) infection is associated with the development of nonalcoholic steatohepatitis (NASH) remains unclear. The FibroScan-aspartate aminotransferase (FAST) score was developed to identify patients who have histologic NASH with high nonalcoholic fatty liver disease activity score (NAS ≥4) and significant liver fibrosis (≥F2), which has been associated with higher risk of end-stage liver disease. We examined whether HIV infection is associated with elevated FAST score in a large United States (US) cohort.

Methods: Vibration-controlled transient elastography was performed in 1309 women without history of chronic viral hepatitis enrolled from 10 US sites: 928 women with HIV (WWH) and 381 women without HIV (WWOH). We used multivariable logistic regression to evaluate associations of HIV, demographic, lifestyle, and metabolic factors with an elevated (>0.35) FAST score.

Results: Median age of WWH and WWOH was 51 years and 48 years, respectively. Most (90%) WWH were on antiretroviral therapy and 72% had undetectable HIV RNA. Prevalence of elevated FAST score was higher among WWH compared to WWOH (6.3% vs 1.8%, respectively; P = .001). On multivariable analysis, HIV infection was associated with 3.7-fold higher odds of elevated FAST score (P = .002), and greater waist circumference (per 10 cm) was associated with 1.7-fold higher odds (P < .001). In analysis limited to WWH, undetectable HIV RNA and current protease inhibitor use were independently associated with lower odds of elevated FAST score.

Conclusions: Our findings suggest that HIV is an independent risk factor for NASH with significant activity and fibrosis. Studies validating FAST score in persons with HIV are warranted.

Keywords: FAST score; VCTE; human immunodeficiency virus; liver steatosis; nonalcoholic steatohepatitis.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. A. A. A. has received consulting fees from Merck, ViiV Healthcare, and Gilead Sciences; Gilead Sciences and Merck have provided her institution with funding for her research. A. A. A. also reports participation on the ACTIV-6 data and safety monitoring board (outside the submitted work); and is a member of the Board of Directors of the Infectious Diseases Society of America and the Governing Council for the International AIDS Society. J. C. P. has received consulting fees from Theratechnologies; Gilead Sciences and Merck have provided her institution with funding for her research. She also reports grants or contracts unrelated to this work from AbbVie; and payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events from Gilead Sciences and Theratechnologies. P. C. T. has received investigator-initiated grants from Merck. M. H. K. reports consulting for Sanofi (payment to author); grant support unrelated to this work from the NIH to his institution; and payment for continuing education lecture for Mount Sinai Health System. A. S. has received funding from Gilead Sciences (grant funding made to institution for unrelated work), and also reports grants or contracts from NIH made to institution and unrelated to this work. A. L. F. reports that a parent NIH grant has supported trips to administrative meetings for the grant and to meetings to present data, outside the submitted work. I. O. reports Merck 022 study and Merck 024 study grants or contracts paid to institution and unrelated to this work:, and personal fees from Accordance. M. P. reports grants or contracts from NIH made to institution and unrelated to this work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.

Figure 1.

Factors associated with FibroScan–aspartate aminotransferase (FAST) score >0.35 among all women (N = 1309) in multivariable analysis. Abbreviations: CI, confidence interval; HIV, human immunodeficiency virus; HOMA-IR, homeostatic model assessment of insulin resistance.

Figure 2.

Figure 2.

Factors associated with FibroScan–aspartate aminotransferase (FAST) score >0.35 among women with human immunodeficiency virus (n = 928) in multivariable analysis. Abbreviations: CI, confidence interval; HIV, human immunodeficiency virus; HOMA-IR, homeostatic model assessment of insulin resistance; PI, protease inhibitor.

References

    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64:73–84. -PubMed
    1. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67:328–57. -PubMed
    1. Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: a review. JAMA 2020; 323:1175–83. -PubMed
    1. Lake JE, Overton T, Naggie S, et al. Expert panel review on non-alcoholic fatty liver disease in persons with human immunodeficiency virus. Clin Gastroenterol Hepatol 2022; 20:256–8. -PMC -PubMed
    1. Campos-Varela I, Dodge JL, Terrault NA, Brandman D, Price JC. Non-viral liver disease is the leading indication for liver transplant in the U.S. in persons living with human immunodeficiency virus. Am J Transplant 2021; 21:3148–56. -PMC -PubMed

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources