Background: Nonalcoholic fatty liver disease (NAFLD) is frequent in people with HIV (PWH). The Fibroscan-aspartate aminotransferase (FAST) score was developed to identify patients with nonalcoholic steatohepatitis (NASH) and significant fibrosis. We investigated prevalence of NASH with fibrosis and the value of FAST score in predicting clinical outcomes in PWH. Methods: Transient elastography (Fibroscan) was performed in PWH without viral hepatitis coinfection from four prospective cohorts. We used FAST>0.35 to diagnose NASH with fibrosis. Incidence and predictors of liver-related outcomes (hepatic decompensation, hepatocellular carcinoma) and extra-hepatic events (cancer, cardiovascular disease) were evaluated through survival analysis. Results: Of the 1472 PWH included, 8% had FAST>0.35. On multivariable logistic regression, higher BMI (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.14-1.29), hypertension (aOR 2.24, 95% CI 1.16-4.34), longer time since HIV diagnosis (aOR 1.82, 95% CI 1.20-2.76) and detectable HIV viral load (aOR 2.22, 95% CI 1.02-4.85) were associated with FAST>0.35. 882 patients were followed for a median of 3.8 years (interquartile range 2.5-4.2). Overall, 2.9% and 11.1% developed liver-related and extra-hepatic outcomes, respectively. Incidence of liver-related outcomes was higher in patients with FAST>0.35 vs. FAST<0.35 (45.1, 95% CI 26.2-77.7 vs. 5.0, 95% 2.9-8.6 per 1000 person-years). On multivariable Cox regression analysis, FAST>0.35 remained an independent predictor of liver-related outcomes (adjusted hazard ratio 4.97, 95% CI 1.97-12.51). Conversely, FAST did not predict extra-hepatic events. Conclusion: A significant proportion of PWH without viral hepatitis coinfection may have NASH with significant liver fibrosis. FAST score predicts liver-related outcomes and can help risk stratification and management in this high-risk population.
Fibroscan-aspartate aminotransferase (FAST) score predicts liver-related outcomes, but not extra-hepatic events, in a multicenter cohort of people with HIV / Sebastiani, Giada; Milic, Jovana; Kablawi, Dana; Gioe', Claudia; Al Hinai, Al Shaima; Lebouché, Bertrand; Tsochatzis, Emmanuel; Finkel, Jemima; Ballesteros, Luz Ramos; Ramanakumar, Agnihotram V; Bhagani, Sanjay; Benmassaoud, Amine; Mazzola, Giovanni; Cascio, Antonio; Guaraldi, Giovanni. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - 77:3(2023), pp. 396-404. [10.1093/cid/ciad203]
Fibroscan-aspartate aminotransferase (FAST) score predicts liver-related outcomes, but not extra-hepatic events, in a multicenter cohort of people with HIV
Guaraldi, Giovanni
2023
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is frequent in people with HIV (PWH). The Fibroscan-aspartate aminotransferase (FAST) score was developed to identify patients with nonalcoholic steatohepatitis (NASH) and significant fibrosis. We investigated prevalence of NASH with fibrosis and the value of FAST score in predicting clinical outcomes in PWH. Methods: Transient elastography (Fibroscan) was performed in PWH without viral hepatitis coinfection from four prospective cohorts. We used FAST>0.35 to diagnose NASH with fibrosis. Incidence and predictors of liver-related outcomes (hepatic decompensation, hepatocellular carcinoma) and extra-hepatic events (cancer, cardiovascular disease) were evaluated through survival analysis. Results: Of the 1472 PWH included, 8% had FAST>0.35. On multivariable logistic regression, higher BMI (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.14-1.29), hypertension (aOR 2.24, 95% CI 1.16-4.34), longer time since HIV diagnosis (aOR 1.82, 95% CI 1.20-2.76) and detectable HIV viral load (aOR 2.22, 95% CI 1.02-4.85) were associated with FAST>0.35. 882 patients were followed for a median of 3.8 years (interquartile range 2.5-4.2). Overall, 2.9% and 11.1% developed liver-related and extra-hepatic outcomes, respectively. Incidence of liver-related outcomes was higher in patients with FAST>0.35 vs. FAST<0.35 (45.1, 95% CI 26.2-77.7 vs. 5.0, 95% 2.9-8.6 per 1000 person-years). On multivariable Cox regression analysis, FAST>0.35 remained an independent predictor of liver-related outcomes (adjusted hazard ratio 4.97, 95% CI 1.97-12.51). Conversely, FAST did not predict extra-hepatic events. Conclusion: A significant proportion of PWH without viral hepatitis coinfection may have NASH with significant liver fibrosis. FAST score predicts liver-related outcomes and can help risk stratification and management in this high-risk population.
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