Nonalcoholic Fatty Liver Disease and the Development of Metabolic Comorbid Conditions in Patients With Human Immunodeficiency Virus Infection

J Infect Dis. 2020 Aug 4;222(5):787-797. doi: 10.1093/infdis/jiaa170.


Background: Cardiovascular and liver disease are main causes of death in people with human immunodeficiency virus (HIV) (PWH). In HIV-uninfected patients, nonalcoholic fatty liver disease (NAFLD) is associated with incident metabolic complications. We investigated the effect of NAFLD on development of metabolic comorbid conditions in PWH.

Methods: We included PWH undergoing a screening program for NAFLD using transient elastography. NAFLD was defined as a controlled attenuation parameter ≥248 dB/m with exclusion of other liver diseases. Incident diabetes, hypertension, dyslipidemia, and chronic kidney disease were investigated using survival analysis and Cox proportional hazards.

Results: The study included 485 HIV-monoinfected patients. During a median follow-up of 40.1 months (interquartile range, 26.5-50.7 months), patients with NAFLD had higher incidences of diabetes (4.74 [95% confidence interval, 3.09-7.27] vs 0.87 [.42-1.83] per 100 person-years) and dyslipidemia (8.16 [5.42-12.27] vs 3.99 [2.67-5.95] per 100 person-years) than those without NAFLD. With multivariable analysis, NAFLD was an independent predictor of diabetes (adjusted hazard ratio, 5.13; 95% confidence interval, 2.14-12.31) and dyslipidemia (2.35; 1.34-4.14) development.

Conclusions: HIV-monoinfected patients with NAFLD are at higher risk of incident diabetes and dyslipidemia. Early referral strategies and timely management of metabolic risk may improve outcomes.

Keywords: controlled attenuation parameter; diabetes; dyslipidemia; liver fibrosis; transient elastography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Body Mass Index
  • Canada / epidemiology
  • Comorbidity
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Dyslipidemias / epidemiology*
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Protease Inhibitors / therapeutic use
  • Humans
  • Hypertension / epidemiology*
  • Incidence
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / etiology
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / complications
  • Non-alcoholic Fatty Liver Disease / diagnostic imaging
  • Non-alcoholic Fatty Liver Disease / epidemiology*
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / epidemiology*
  • Retrospective Studies
  • Risk Factors


  • HIV Protease Inhibitors