Clinical, biochemical and histological differences between HIV-associated NAFLD and primary NAFLD: a case-control study

BackgroundThere are limited data regarding the clinical, biochemical and liver histological characteristics of patients with HIV-associated nonalcoholic fatty liver disease (NAFLD), and whether this entity differs in presentation and severity from primary NAFLD AimTo examine the clinical and histological differences between HIV-associated NAFLD and primary NAFLD. MethodsThis is a cross-sectional, case-control study comparing patients with HIV-associated NAFLD vs. patients with primary NAFLD. HIV-infected patients were identified from a database of consecutive liver biopsies performed atthe University of California at San Diego, over a 13-year period. HIV-infected patients with biopsy-proven NAFLD were selected as cases, after exclusion of other causes of liver disease and hepatic steatosis. Age-sex-matched controls with biopsy-proven primary NAFLD were randomly identified from the same pathology database. All biopsies underwent a standardised, detailed, histological research evaluation by a liver pathologist who was blinded to clinical and case-control status. ResultsCompared to age-sex-matched patients with primary NAFLD (n=33), patients with HIV-associated NAFLD (n=33) had significantly higher mean aspartate aminotransferase (P<0.001), alanine aminotransferase (P<0.001), alkaline phosphatase (P=0.003) and serum triglycerides (P=0.024). Similarly, compared to age-sex-matched primary NAFLD, patients with HIV-associated NAFLD had significantly higher rates of definite steatohepatitis (37% vs. 63%, P=0.04), and more features of liver injury, including lobular inflammation (<0.001) and acidophil bodies (<0.001). ConclusionCompared to age-sex-matched primary NAFLD, HIV-associated NAFLD has increased severity of liver disease and a higher prevalence of NASH.