Epicardial fat and liver stiffness by acoustic radiation force impulse elastography in people with HIV-1 infection without liver disease

Objective: To evaluate the association between increased epicardial fat thickness (EFT) and liver stiffness measurement (LSM), as assessed by elastography in people with human immunodeficiency virus type 1 (HIV-1) infection (PWH).

Methods: Ninety-one PWH on effective antiretroviral treatment (ART) were enrolled. EFT was measured by transthoracic echocardiography. Liver steatosis was evaluated by ultrasound Hamaguchi criteria and LSM by elastography with acoustic radiation force impulse (ARFI) technique. LSM ≥8 kPa was suggestive of clinically relevant fibrosis.

Results: Mean age was 54.3 years and 27.5% were women. EFT correlated with HIV-1 infection duration (rS 0.252, P = 0.016), age at study entry (rS 0.527, P < 0.001), BMI (rS 0.363, P < 0.001), waist circumference (rS 0.549, P < 0.001), HDL (rS -0.391, P < 0.001), triglycerides (rS 0.375, P < 0.001), Hamaguchi score (rS 0.279, P = 0.007), right lobe of the liver (rS 0.259, P = 0.014), left ventricular mass/body surface area (rS 0.220, P = 0.036).A LSM ≥8 kPa was found in 20.9% of PWH, more commonly in those with EFT above the median >5.6 mm (30.4% vs. 11.1%, P = 0.038). LSM significantly correlated with EFT (rS 0.274, P = 0.009), CD4 + cells (rS -0.320, P = 0.003) and nadir of CD4 + cells (rS -0.292, P = 0.007).In a subgroup ( n = 53), a homeostasis model assessment of insulin resistance (HOMA-IR) index >2.33 identified increased EFT, [area under the curve (AUC) 0.73, 95% confidence interval (CI) 0.59-0.84, P = 0.001) while an HOMA-IR >3.27 predicted increased LSM (AUC 0.76, 95% CI 0.62-0.87, P = 0.005).

Conclusions: PWH with increased EFT have worse metabolic profile and a high proportion of clinically relevant fibrosis at ARFI elastography, despite normal liver function tests. The HOMA-IR index might be used to identify PWH with increased EFT and liver fibrosis.