Nonalcoholic fatty liver disease in HIV-infected patients referred to a metabolic clinic: Prevalence, characteristics, and predictors

Giovanni Guaraldi*, Nicola Squillace, Chiara Stentarelli, Gabriella Orlando, Roberto D'Amico, Guido Ligabue, Federica Fiocchi, Stefano Zona, Paola Loria, Roberto Esposito, Frank Palella

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

189 Scopus citations


Background. The prevalence and predictors of nonalcoholic fatty liver disease (NAFLD) in human immunodeficiency virus (HIV)-infected highly active antiretroviral therapy-experienced patients and the association of NAFLD with risk of cardiovascular disease and subclinical atherosclerosis are unknown. Methods. We performed a cross-sectional observational study. NAFLD was defined by liver-spleen attenuation values of >1.1 on computed tomography in persons who had neither evidence of chronic viral hepatitis nor a significant history of alcohol consumption. Results. We enrolled 225 patients; 163 (72.4%) were men. Mean (±SD) HIV infection duration was 147 ± 60 months, and mean (±SD) body mass index (calculated as weight in kilograms divided by the square of height in meters) was 23.75 ± 3.59. NAFLD was diagnosed in 83 patients (36.9% of the total cohort). The following variables were significantly associated with NAFLD in univariate analyses: sex, waist circumference, body mass index, cumulative exposure to nucleoside reverse-transcriptase inhibitors, visceral adipose tissue, homeostasis model assessment of insulin resistance index, serum alanine and aspartate aminotransferase levels, and ratios of total serum cholesterol to high-density lipoprotein cholesterol. Coronary artery calcium scores and a diagnosis of diabetes were not associated with NAFLD. In multivariable logistic regression analyses, factors associated (P < .001) with NAFLD were higher serum alanine to aspartate ratio (odds ratio, 4.59; 95% confidence interval, 2.09-10.08), male sex (odds ratio, 2.49; 95% confidence interval, 1.07-5.81), greater waist circumference (odds ratio, 1.07; 95% confidence interval, 1.03-1.11), and longer nucleoside reverse-transcriptase inhibitor exposure (odds ratio, 1.12 per year of exposure; 95% confidence interval, 1.03-1.22). Conclusions. NAFLD is common among HIV-infected persons who have the traditional risk factors for NAFLD (elevations in serum alanine level, male sex, and increased waist circumference) apparent. Exposure to nucleoside reverse-transcriptase inhibitors was an independent risk factor for NAFLD, with an 11% increase in the odds ratio for each year of use.

Original languageEnglish (US)
Pages (from-to)250-257
Number of pages8
JournalClinical Infectious Diseases
Issue number2
StatePublished - Jul 15 2008

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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