Abstract
Objective: Hepatic steatosis is common in HIV-infected individuals. Magnetic resonance spectroscopy (MRS) is the preferred noninvasive method for hepatic steatosis measurement but is expensive. Controlled attenuation parameter (CAP) also assesses hepatic steatosis and is conveniently performed concomitantly with transient elastography. We aimed to assess the accuracy of CAP in the setting of HIV infection. Design: Cross-sectional study. Methods: CAP and MRS were performed in 82 study participants (39 HIV monoinfected; seven hepatitis C virus (HCV) monoinfected; 21HIV/HCV coinfected; 15 with neither infection). We used concordance correlation coefficients to compare log-transformed and standardized CAP and MRS values and linear regression to examine factors associated with CAP and MRS-measured hepatic steatosis (MRS-HS). The accuracy of CAP to detect at least mild hepatic steatosis, defined as MRS-liver fat fraction more than 0.05, and the factors associated with discordance between CAP and MRS were evaluated. Results: Overall, CAP-measured hepatic steatosis and MRS-HS correlated moderately well (r c =0.63; P<0.001), and correlation was strongest in the HIV-monoinfected group (r c =0.67; P<0.001). Body composition factors (higher BMI, waist circumference, visceral and abdominal subcutaneous adipose tissue) and insulin resistance were significantly associated with both greater CAP-measured hepatic steatosis and MRS-HS. Using a validated CAP cut-off of at least 238dB/m, sensitivity and specificity for at least mild hepatic steatosis were 84% and 75% in the entire cohort; 89% and 80% in the HIV-monoinfected group. Participants with higher body composition parameters were more likely to be misclassified as having hepatic steatosis by CAP. Conclusion: Our findings suggest CAP is an acceptable noninvasive surrogate for hepatic steatosis in HIV-infected individuals but may overestimate hepatic steatosis prevalence, especially in individuals with high BMI. Evaluation of factors that improve CAP accuracy and determination of optimal cut-offs are warranted.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2119-2125 |
| Number of pages | 7 |
| Journal | AIDS |
| Volume | 31 |
| Issue number | 15 |
| DOIs | |
| State | Published - Sep 24 2017 |
Funding
The work was supported by an ACG Junior Faculty Development Award from the American College of Gastroenterology and the Gilead Research Scholars Program in HIV. The Women's Interagency HIV Study (WIHS) is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID) (U01-AI-103401, U01-AI-103408, UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, U01-AI-103397, U01-AI-103390, UO1-AI-34989, and UO1-AI-42590), with additional cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research onWomen's Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA). This study was also supported by the UCSF Liver Center National Institute of Health (P30 DK026743), by the National Institute of Allergy and Infectious Diseases (K24 AI 108516 and R01 AI 087176, which was administered by the Northern California Institute for Research and Education and with resources of the Veterans Affairs Medical Center, San Francisco, California USA], and by a grant from the National Institutes of Health, University of California, San Francisco-Gladstone Institute of Virology and Immunology Center for AIDS Research, P30-AI027763. Data in this manuscript were collected by the WIHS. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).
Keywords
- controlled attenuation parameter
- fatty liver
- HCV
- hepatic steatosis
- HIV
- magnetic resonance spectroscopy
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases
