Impact of Nonalcoholic Fatty Liver Disease on the Survival of People Living With HIV

Background: Nonalcoholic fatty liver disease (NAFLD) is an increasing concern for people living with HIV (PLWH). However, information on the impact of NAFLD on the prognosis of PLWH is very scarce.

Aims: To investigate the influence of NAFLD on the overall and liver-related mortality in PLWH.

Methods: PLWH followed in three Spanish centres were included in a prospective cohort at the date of the first transient elastography evaluation. Survival data were recorded, and the causes of death were centrally monitored. The risk of all-cause death and liver-related death was evaluated by applying time-to-event analyses.

Results: A total of 2151 PLWH were included in the cohort and followed for a median (Q1-Q3) of 7.3 (3.5-10.4) years. There were 174 (8.1%) deaths. The probability of overall death and liver-related death was associated with liver stiffness measurement (LSM) and with FibroScan-AST (FAST) score. Among 844 PLWH with potential for NALFD, LSM was independently associated with all-cause mortality (adjusted hazard ratio [AHR], by 1 kPa increase: 1.06; 95% confidence interval [95% CI]: 1.04-1.08; p < 0.001). In a separate model and after adjustment, FAST score ≥ 0.67 was related to survival (AHR: 1.87; 95% CI: 1.40-2.50; p < 0.001). The AUROC (95% CI) of the models were based on LSM, 0.812 (0.739-0.885); and FAST, 0.825 (0.753-0.897) (p = 0.386).

Conclusions: For PLWH, advanced liver fibrosis increases the risk of overall death and liver-related death. LSM and the FAST score are similar predictors of survival for PLWH with potential for NAFLD.