Metabolic causes of liver disease among adults living with HIV from low- and middle-income countries: a cross-sectional study.

Autor: Plaisy MK; University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France., Minga AK; Blood Bank Medical Centre, the HIV care clinic of the National Blood Transfusion Centre, Abidjan, Côte d'Ivoire., Wandeler G; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland., Murenzi G; Research for Development (RD Rwanda) and Rwanda Military Hospital, Kigali, Rwanda., Samala N; Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA., Ross J; TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand., Lopez A; Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Mensah E; NGO Espoir-Vie Togo, Lomé, Togo., de Waal R; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa., Kuniholm MH; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA., Diero L; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya., Salvi S; Byramjee Jeejeebhoy Government Medical College, Pune, India., Moreira R; Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil., Attia A; University Hospital of Yopougon, Abidjan, Côte d'Ivoire., Mandiriri A; Newlands Clinic, Harare, Zimbabwe., Shumbusho F; Research for Development (RD Rwanda) and Rwanda Military Hospital, Kigali, Rwanda., Goodrich S; Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA., Rupasinghe D; The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia., Alarcon P; Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Maruri F; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Perrazo H; Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil., Jaquet A; University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2024 Apr; Vol. 27 (4), pp. e26238.
DOI: 10.1002/jia2.26238
Abstrakt: Introduction: Liver disease is a leading cause of morbidity and mortality among persons living with HIV (PLHIV). While chronic viral hepatitis has been extensively studied in low- and middle-income countries (LMICs), there is limited information about the burden of metabolic disorders on liver disease in PLHIV.
Methods: We conducted a cross-sectional analysis of baseline data collected between October 2020 and July 2022 from the IeDEA-Sentinel Research Network, a prospective cohort enrolling PLHIV ≥40 years on antiretroviral treatment (ART) for ≥6 months from eight clinics in Asia, Americas, and central, East, southern and West Africa. Clinical assessments, laboratory testing on fasting blood samples and liver stiffness measurement (LSM)/controlled attenuation parameter (CAP) by vibration-controlled transient elastography were performed. Multivariable logistic regression models assessed factors associated with liver fibrosis (LSM ≥7.1 kPa) and steatosis (CAP ≥248 dB/m). Population attributable fraction (PAF) of each variable associated with significant liver fibrosis was estimated using Levin's formula.
Results: Overall, 2120 PLHIV (56% female, median age 50 [interquartile range: 45-56] years) were included. The prevalence of obesity was 19%, 12% had type 2 diabetes mellitus (T2DM), 29% had hypertension and 53% had dyslipidaemia. The overall prevalence of liver fibrosis and steatosis was 7.6% (95% confidence interval [CI] 6.1-8.4) and 28.4% (95% CI 26.5-30.7), respectively, with regional variability. Male sex at birth (odds ratio [OR] 1.62, CI 1.10-2.40), overweight/obesity (OR = 2.50, 95% CI 1.69-3.75), T2DM (OR 2.26, 95% CI 1.46-3.47) and prolonged exposure to didanosine (OR 3.13, 95% CI 1.46-6.49) were associated with liver fibrosis. Overweight/obesity and T2DM accounted for 42% and 11% of the PAF for liver fibrosis, while HBsAg and anti-HCV accounted for 3% and 1%, respectively. Factors associated with steatosis included overweight/obesity (OR 4.25, 95% CI 3.29-5.51), T2DM (OR 2.06, 95% CI 1.47-2.88), prolonged exposure to stavudine (OR 1.69, 95% CI 1.27-2.26) and dyslipidaemia (OR 1.68, 95% CI 1.31-2.16).
Conclusions: Metabolic disorders were significant risk factors for liver disease among PLHIV in LMICs. Early recognition of metabolic disorders risk factors might be helpful to guide clinical and lifestyle interventions. Further prospective studies are needed to determine the causative natures of these findings.
(© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Databáze: MEDLINE
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