Prevalence and Risk Factors of Moderate to Severe Hepatic Steatosis in HIV Infection: The Copenhagen Co-Morbidity Liver Study.

BACKGROUND: People living with HIV (PWH) may be at risk of non-alcoholic fatty liver disease (NAFLD). We compared the prevalence of moderate-to-severe hepatic steatosis (M-HS) in PWH with HIV-uninfected controls and determined risk factors for M-HS in PWH. METHODS: The Copenhagen Co-Morbidity in HIV infection Study included 453 participants and the Copenhagen General Population Study 765 participants. None had prior or current viral hepatitis or excessive alcohol intake. M-HS was assessed by unenhanced CT liver scan defined by liver attenuation ≤48 Hounsfield units. Adjusted odds ratios (aOR) were computed by adjusted logistic regression. RESULTS: The prevalence of M-HS was lower in PWH compared to uninfected controls (8.6% vs. 14.2%, p<0.01). In multivariable analyses, HIV (aOR:0.44, p<0.01); female sex (aOR:0.08, p=0.03); physical activity level (aOR 0.09 very active vs inactive, p<0.01); and alcohol (aOR:0.89 per unit/week, p=0.02) was protective factors, while BMI (aOR:1.58 per 1 kg/m2, p<0.01); ALT (aOR:1.76 per 10 U/L, p<0.01); and exposure to integrase inhibitors (aOR: 1.28 per year, p=0.02) were associated with higher odds of M-HS. CONCLUSIONS: Moderate-to-severe hepatic steatosis is less common in PWH compared to demographically comparable uninfected controls. Besides BMI and ALT, integrase inhibitor exposure was associated with higher prevalence of steatosis in PWH.