Non-viral liver disease burden in people living with HIV and elevated transaminases: a cross-sectional study

Introduction: Due to improved life expectancy in people living with HIV (PLWH), liver disease is increasingly being recognised. We assessed non-viral chronic liver disease (CLD) burden in PLWH. Methods: The HeAL (HIV non-virAL liver disease) study (2014-2021) prospectively recruited PLWH with elevated serum alanine aminotransferase (ALT) levels and negative hepatitis serology. Clinically significant hepatic fibrosis (CSHF) was defined as liver stiffness measurement (LSM) of >7.1 kPa and hazardous alcohol use as AUDIT score > 8. Primary outcome was prevalence/predictors of CSHF. Results: Total recruited were n=274, 92% male, median age 52 (45-59) years, 96% having undetectable HIV viral load. Overall, n=97 (35%) had hazardous alcohol use, n=72 (26%) had metabolic syndrome (MS) and 17%-27% had exposure to hepatotoxic antiretrovirals (ARV). Prevalence of CSHF was 20% (n=54), prevalence of cirrhosis (LSM >12.5 kPa) being 7% (19/274). Risk factors for CSHF were hazardous alcohol use in 44% (n=24), MS in 46% (n=25) and hepatotoxic ARV in 56% (n=30), majority having more than one risk factor. Independent predictors of CSHF were serum HDL (OR 0.220; 95% CI 0.061-0.790, p=0.020) (inverse relationship); serum AST (OR 1.033, 95% CI 1.001-1.067, p=0.045) and didanosine use (OR 2.878, 95% CI 1.228-6.774, p=0.015). Moderate-severe hepatic steatosis was identified in 52%(n=142). Both FIB-4 and APRI performed poorly in predicting CSHF (PPV 27.3% and 30.6% respectively) and advanced fibrosis(>F3) (PPV 17.6% and 5.9% respectively). Conclusion: In this study, 20% of PLWH had CSHF associated with high prevalence of hazardous alcohol use/MS/potentially hepatotoxic ARV. These potentially modifiable risk factors need addressing.