Alcoholic Liver Disease in People with Hiv in Low- and Middle-Income Countries: Prevalence and Factors Associated with Severity of Hepatic Fibrosis

Archive ouverte

Samala, Niharika R. Goodrich, Suzanne | Plaisy, Marie Kerbie | Jaquet, Antoine | Wandeler, Gilles Chimbetete, Cleophas Rupasinghe, Dhanushi Salvir, Sonali | Kuniholm, Mark H. Lancaster, Kathy | Perazzo, Hugo | Moreira, Rodrigo | Duda, Stephanie | Chalasani, Naga P. Sameere, Agrrey

Edité par CCSD -

International audience. Background: In people with HIV (PWHIV) in the US, active alcohol use is associated with alcohol-associated liver disease (ALD). Worldwide 5% of global disease burden is attributable to alcohol consumption. Among PWHIV 30% have alcohol use disorder. ALD has not been explored in PWHIV in low- and middle-income countries. We aimed to determine the prevalence of ALD and associated fibrosis severity in PWHIV. Methods: PWHIV ≥ 40 years and ≥ 6 months on antiretroviral therapy were prospectively enrolled in the Sentinel Research Network (SRN) of the IeDEA (International epidemiology Databases to Evaluate AIDS) consortium (Asia-Pacific, Central Africa, East Africa, Southern Africa, West Africa, Caribbean, Central and South America networks) were analyzed. All participants who completed AUDIT questionnaire to determine alcohol use and had reliable Vibration Controlled Transient Elastography using FibroScan® (≥ 10 valid reads & ≤ 30% IQR) to determine hepatic steatosis and fibrosis were included. ALD was defined as a Controlled Attenuation Parameter ≥ 285dB/m and an AUDIT-score ≥ 7 in females and ≥ 8 in males. Clinically significant fibrosis (CSF) was defined as Liver Stiffness Measurement (LSM) ≥ 8.6kPa. Metabolic syndrome was defined based on ATP-III definition. Analysis was performed using SAS. Results: There were 2333 PWHIV in the IeDEA-SRN cohort, 57% females, with median age of 51 (46, 56) years, median BMI of 25 (22, 28) kg/m2; 8% had diabetes, 23% had hypertension, 55% had dyslipidemia and 28% had metabolic syndrome. Hazardous alcohol use was seen in 12% (275). ALD was seen in 1.2% (29) of the entire cohort and in 11% of those with hazardous alcohol use. Liver disease other than ALD was seen in 372 (16%) of the cohort. Among those with ALD, 17% (5/29) had CSF. PWHIV with ALD had higher median BMI (29 vs. 24 kg/m2, p<0.0001), were more likely to be male (79% vs. 41%, p<0.0001), have type 2 diabetes (17% vs. 6%, p=0.03), and metabolic syndrome (55% vs 29%, p=0.008) compared to those without liver disease. Furthermore, PWHIV with ALD had significantly higher LSM (median (IQR) 5.2 (4.4, 5.9) vs. 4.6 (3.8, 5.5), p=0.009), and CSF (5 (17%) vs. 60 (3%), p=0.002) compared to those without liver disease. Conclusion: In low to middle income countries, ALD is present in 1.2% of PWHIV and in 11% of PWHIV with hazardous alcohol use. A sizable proportion of PWHIV with ALD have evidence for clinically significant fibrosis. Metabolic syndrome may predispose PWHIV to ALD

• Description
• Sujet/Public
• Outil
• Outil d'anticipation
• Mémoire et thèse
• Gestion