Background:  Non-alcoholic Fatty Liver Disease (NAFLD) occurs among persons without chronic viral hepatitis or significant alcohol consumption. It presents often in the context of cardiovascular risk factors. Our objectives were to assess the incidence and predictors of NAFLD in HIV-infected HAART-experienced patients.

Methods:  This was a 48-week prospective observational study. NAFLD was defined using a liver/spleen attenuation value <1.1 by computed tomography in persons without serum hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, or a significant history of alcohol consumption. Incidence was defined as the proportion of subjects meeting diagnostic criteria at follow-up. Compared to baseline liver/spleen values, quartiles were used to classify people whose liver steatosis (liver/spleen) improved (fourth quartile) or worsened (first quartile) during follow-up. We used Student’s t tests and univariate logistic regression models to identify liver/spleen risks and predictors of improvement or worsening.

Results:  We enrolled 57 patients, 44 (77%) of whom were male. Baseline mean age was 49 years; body mass index, 23.76±3.45; 27.8% were CDC group C; mean duration of antiretroviral (ARV) exposure (in months) was:  NRTI 117±41, NNRTI 33±29; protease inhibitor (PI), 65±36 months; 88% had lipodystrophy, and 25% had metabolic syndrome. NAFLD was present in 26 patients (prevalence of 45.61%). At follow-up, NAFLD was diagnosed in 25 patients (incidence of 43.86%). One-year incidence of NAFLD was 4/57 (7%). Analysis of quartile distribution at 48 weeks revealed 4 subjects (14%) with improved and 4 subjects (14%) with worsened liver/spleen. Univariate logistic regression models revealed that improvement in liver/spleen indicators was associated with:  higher baseline serum HDL (68.67±22.3 in those who improved vs 41.47±14.29 in those who did not, p <0.001), higher baseline apolipoprotein (Apo) A (178.67±46.2 vs 130.51±29.29, p = 0.01), less cumulative NRTI exposure (80±41.7 vs 121.5±41.06, p = 0.05), greater baseline leg fat mass (3501±1338 vs 2037±1268, p = 0.05).Worsening of liver/spleen indicators was associated with:  higher baseline serum triglyceride (TG, 426.25±529.7 vs 176.98±95.2, p <0.001); higher baseline total cholesterol (270.25±71.28 vs 191.74±40.01, p = 0.04); higher baseline ApoB (135.5±32.71 vs 107.28±27.22, p = 0.05); higher baseline serum insulin (22.68±6.10 vs 14.03±7.76, p = 0.03); lower baseline spleen density (35.22±16.64 vs 50.9±3.81, p <0.001); reduction in serum HDL (–9.5±9.04 vs –0.12±8.59, p = 0.04)

Conclusions:  NAFLD is a highly prevalent in HIV-infected persons. Its development is more likely in the presence of traditional metabolic cardiovascular risks and with greater NRTI exposure.