Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia.

Chihota, Belinda Varaidzo; Riebensahm, Carlotta; Muula, Guy; Sinkala, Edford; Chilengi, Roma; Mulenga, Lloyd; Bosomprah, Samuel; Vinikoor, Michael J; Bolton-Moore, Carolyn; Egger, Matthias; Rauch, Andri; Berzigotti, Annalisa; Wandeler, Gilles (2022). Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia. BMJ open gastroenterology, 9(1), e000945. BMJ Publishing Group 10.1136/bmjgast-2022-000945

[img]
Preview
Text
e000945.full.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (367kB) | Preview

INTRODUCTION

The growing importance of non-communicable diseases (NCDs) and high HIV prevalence in urban African settings may increase the burden of metabolic dysfunction-associated fatty liver disease (MAFLD). We assessed liver steatosis among HIV-positive and negative adults in urban Zambia.

METHODS

Adults 30 years and older who were newly diagnosed with HIV, or tested HIV-negative at two primary care clinics in Lusaka, Zambia, were assessed for liver steatosis. Cardiometabolic data were collected through comprehensive clinical and laboratory assessments. Transient elastography was performed to measure controlled-attenuation parameter (≥248 dB/m). We used multivariable logistic regression models to determine the factors associated with the presence of steatosis.

RESULTS

We enrolled 381 patients, including 154 (40%) antiretroviral therapy-naïve people living with HIV (PLWH) with a median CD4+ count of 247 cells/mm3 and a mean body mass index (BMI) of 23.8 kg/m2. Liver steatosis was observed in 10% of participants overall and was more common among HIV-negative adults than in PLWH (15% vs 3%). The proportion of patients with steatosis was 25% among obese (BMI ≥30 kg/m2) participants, 12% among those overweight (BMI 25-29.9 kg/m2), and 7% among those with a BMI <25 kg/m2. Among patients with a fasting glucose ≥7 mmol/L or confirmed diabetes, 57% had liver steatosis. In multivariable analyses, HIV status (adjusted odds ratio (aOR) 0.18, 95% CI 0.06 to 0.53), confirmed diabetes or elevated fasting glucose (aOR 3.92, 95% CI 1.57 to 9.78) and elevated blood pressure (aOR 2.95, 95% CI 1.34 to 6.48) were associated with steatosis. The association between BMI>25 kg/m2 and liver steatosis was attenuated after adjustment for potential confounders (aOR 1.96, 95% CI 0.88-4.40). Overall, 21 (9%) participants without HIV and 4 (3%) with HIV met the criteria for MAFLD. Among individuals with liver steatosis, 65% (95% CI 49% to 80%) fulfilled criteria of MAFLD, whereas 15 (39%) of them had elevated transaminases and 3 (8%) F2-F4 fibrosis.

CONCLUSIONS

The prevalence of liver steatosis in this urban cohort of HIV-positive and negative adults in Zambia was low, despite a large proportion of patients with high BMI and central obesity. Our study is among the first to report data on MAFLD among adults in Africa, demonstrating that metabolic risk factors are key drivers of liver steatosis and supporting the adoption of the criteria for MAFLD in African populations.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Chihota, Belinda Varaidzo, Riebensahm, Carlotta Luise Elisabeth, Egger, Matthias, Rauch, Andri, Berzigotti, Annalisa, Wandeler, Gilles

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

2054-4774

Publisher:

BMJ Publishing Group

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Pubmed Import

Date Deposited:

18 Jul 2022 09:14

Last Modified:

05 Dec 2022 16:21

Publisher DOI:

10.1136/bmjgast-2022-000945

PubMed ID:

35831020

Uncontrolled Keywords:

FATTY LIVER HIV/AIDS LIVER

BORIS DOI:

10.48350/171295

URI:

https://boris.unibe.ch/id/eprint/171295

Actions (login required)

Edit item Edit item
Provide Feedback