Title : Interest of CAP (controlled attenuation parameter) in screening for hepatic steatosis in HIV monoinfected patients
Introduction: Patients living with HIV (PLHIV) are at high risk of developing hepatic steatosis, even in the absence of HBV/HCV co-infection, due to chronic HIV infection, lifelong use of antiretroviral drugs (ARVs) and the frequency of co-morbidities such as overweight, diabetes or insulin resistance. The aim of our study is to evaluate the prevalence of hepatic steatosis and associated factors in 30 HCV/HB uninfected PLWHIV already on antiretroviral therapy (ARV).
Patients and methods: This is a prospective cross-sectional study conducted at our infectious and tropical diseases centre enrolling 30 PLWH. These patients were screened for hepatic steatosis between 01/07/2022 and 31/12/2022. This screening included a fibroscan (WTP values were classified into 4 grades: < 238 dB/m (no steatosis), 238 to 258 dB/m (mild steatosis), 259 to 291 dB/m (moderate steatosis) and ≥ 292 dB/m (severe steatosis)), a liver ultrasound as well as the measurement of parameters allowing the calculation of the Fatty Liver Index (FLI)(triglycerides, gamma GT, body mass index (BMI) and waist circumference). A FLI score ≥ 60 defines the presence of fatty liver disease. Results: We identified 30 PLHIV. The mean age was 48 years, the sex ratio M/F was 2 (20 men and 10 women). The average follow-up time of the infection was 9 years. The mean CD4 count was 745 c/mm3 (including 4 PLWH < 200 c/mm3). 75% of the PLHIV had an undetectable viral load, 74% were at stage c. All the patients were on nucleoside reverse transcriptase inhibitors (NRTI), 65% of whom were on triple therapy: zidovudine+lamivudine+efavirenz and 7% on antiproteases. Regarding the distribution of risk factors associated with steatosis, 4 patients (14%) were diabetic, 7 patients (24%) had lipodystrophy, 5 patients (17%) were obese (median BMI 26.2 kg/m2 versus 22.4 kg/m2 in the rest of the non-obese PLWH), 4 patients (14%) had a metabolic syndrome and only one patient was hypertensive. The median transaminases were 33 IU/ml for AST and 32 IU/ml for ALT. Fibroscans were performed in all PHAs. The FLI score could be measured in 26 patients (87%) and liver ultrasound was performed in 10 patients (34%). Fibroscans showed hepatic steatosis in 12 cases (40%): mild in 3 patients (median WTP 249 dB/m); moderate in 6 patients (median WTP 270 dB/m) and severe steatosis in 3 patients, of which 4 patients had lipodystrophy, 3 patients were obese, 2 patients had metabolic syndrome and only one patient was diabetic. The FLI score was ≥ 60 in 5 patients (17%) and liver ultrasound found hepatic steatosis in 4 patients (14%). Correlation analysis showed that the WTP value was positively and significantly correlated with all three tests.
Conclusion: Our study showed the association between hepatic steatosis and HIV infection due to both chronic infection and lifelong use of ARVs underlines the need for this screening and for the availability of new non-invasive tools currently used in the general population, notably the fibroscan.