Metabolic-Associated Fatty Liver Disease (MAFLD) is associated with immune activation, increased epicardial fat volume, and steatohepatitis among people with HIV in a Thai cohort

Win Min Han; Tanakorn Apornpong; Pairoj Chattranukulchai; Sarawut Siwamogsatham; Hay Mar Su Lwin; Jedsadakorn Boonrungsirisap; Thanathip Wichiansan; Sivaporn Gatechompol; Sasiwimol Ubolyam; Stephen J Kerr; Pisit Tangkijvanich; Anchalee Avihingsanon

doi:10.1111/hiv.13499

Metabolic-Associated Fatty Liver Disease (MAFLD) is associated with immune activation, increased epicardial fat volume, and steatohepatitis among people with HIV in a Thai cohort

HIV Med. 2023 Sep;24(9):1000-1012. doi: 10.1111/hiv.13499. Epub 2023 May 11.

Authors

Win Min Han^{1

2}, Tanakorn Apornpong¹, Pairoj Chattranukulchai³, Sarawut Siwamogsatham^{4

5}, Hay Mar Su Lwin¹, Jedsadakorn Boonrungsirisap¹, Thanathip Wichiansan¹, Sivaporn Gatechompol^{1

6}, Sasiwimol Ubolyam^{1

6}, Stephen J Kerr^{1

2

7}, Pisit Tangkijvanich⁸, Anchalee Avihingsanon^{1

6}

Affiliations

¹ HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
² The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
³ Division of Cardiovascular Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
⁴ Division of Ambulatory and Hospital Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁵ Chula Clinical Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁶ Center of Excellence in Tuberculosis Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁷ Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁸ Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

PMID: 37165782
DOI: 10.1111/hiv.13499

Abstract

Introduction: A change in terminology from fatty liver disease to metabolic-associated fatty liver disease (MAFLD), along with modified diagnostic criteria, was proposed in 2020, and data regarding MAFLD burden in people living with HIV are limited. We investigated associations between MAFLD and immune activation, cardiovascular disease (CVD) risks including epicardial fat volume, and steatohepatitis in an Asian cohort.

Methods: We evaluated CVD risk (epicardial fat tissue, coronary artery calcium [CAC] score, and 10-year atherosclerotic CVD [ASCVD] score) in people living with HIV aged >50 years. Individuals with excessive alcohol consumption and viral hepatitis infections were excluded. MAFLD diagnosis was based on 2020 International Consensus criteria. Non-alcoholic steatohepatitis (NASH) with significant activity and liver fibrosis was defined as FibroScan-aspartate aminotransferase (FAST) score ≥0.67 and >0.35. Multivariate logistic regression models were used to investigate factors associated with MAFLD and NASH with significant activity and liver fibrosis.

Results: The median age was 54 years (interquartile range [IQR] 52-60) and current CD4 count was 613 (IQR 467-804) cells/mm³ . A total of 37% were female, and most (98%) people living with HIV were virally suppressed. The prevalence of MAFLD and non-alcoholic fatty liver disease was 35% and 38%, respectively. In multivariate analyses, higher body mass index, albumin, epicardial fat volume, and liver stiffness were significantly associated with MAFLD. A higher CD4/CD8 ratio was associated with a lower risk of MAFLD. People with HIV with MAFLD had higher odds of having NASH with significant activity and liver fibrosis (adjusted odds ratio 3.3; 95% confidence interval 1.6-6.6), and similar associations were also observed among different MAFLD categories.

Conclusions: The complex relationship between MAFLD and immune activation, steatohepatitis, and epicardial fat tissue suggests an increased risk of advanced liver disease and CVDs beyond the traditional risk factors in people living with HIV with fatty liver disease.

Keywords: Asia; HIV; aging; liver steatosis; metabolic-associated fatty liver disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases*
Female
HIV Infections* / complications
Humans
Male
Middle Aged
Non-alcoholic Fatty Liver Disease* / complications
Southeast Asian People