Screening and Follow-up in Patients With HIV Infection Combined With Metabolic Associated Fatty Liver Disease

Chronic liver disease is now a leading cause of non-AIDS-related death, representing 13% of all deaths in this patient population. While coinfection with viral hepatitis is the primary cause of liver disease, hepatic steatosis is emerging as a major contributor. NAFLD is defined by liver steatosis, the accumulation of triglycerides in the hepatocytes, in the absence of a secondary cause such as excessive alcohol consumption. The condition encompasses a spectrum of diseases from nonalcoholic fatty liver to NASH, fibrosis and cirrhosis. Recent studies report a wide range of prevalence of NAFLD between 15% and 60% among HIV patients. In non-HIV patients NAFLD is principally the hepatic manifestation of the metabolic syndrome, occurring in the context of insulin resistance, central obesity and dyslipidaemia, with disease progression involving a number of complex interacting factors such as genetic susceptibility, oxidative stress and dysbiosis. There is a growing body evidence for weight gain following initiating integrase inhibitor therapy, particularly with dolutegravir and bictegravir. However, the consequences of weight gain have not been evaluated.

Identifying patients at risk of NAFLD, especially severe disease with NASH and fibrosis, is critical. Prevalence of NAFLD in PLWH evaluated by different imaging techniques varies from 13% to 58.6% in all published studies. In previous studies, the effect of ARTon NAFLD was limited. A cross-sectional analysis found that INSTI was associated with a higher prevalence of steatosis in AIDS patients. However, it is not clear whether there is a difference in the degree of nonalcoholic steatosis between AIDS patients receiving NNRTI.

Transient elastography is a non-invasive technique to measure UAP(ultrasound attenuation parameter)and liver stiffness simultaneously. The former reflects the degree of hepatic steatosis. The typical features of fatty liver on abdominal ultrasonography include bright liver echotexture, deep attenuation of ultrasound signal and vascular blunting. The latter two features are because of the faster attenuation of ultrasound wave amplitude in a steatotic liver. UAP takes advantage of this physical property and estimates the ultrasound attenuation at the central frequency of transient elastography, while assuming a homogeneous fat distribution and an adequate penetration.

Therefore, the investigators plan to conduct a prospective study to assess whether there is any difference in the degree of nonalcoholic steatosis and fibrosis between Chinese HIV/AIDS patients after initial treatment with NNRTI or INSTI, or switching from NNRTI to INSTI.