Objective: People with HIV (PWH) have high risk of liver fibrosis. We investigated the effect of weight gain and metabolic dysfunction-associated steatotic liver disease (MASLD) on liver fibrosis dynamics. Design: Multicenter cohort study. Methods: Fibrosis progression was defined as development of significant fibrosis (liver stiffness measurement [LSM]≥8 kPa), or transition to cirrhosis (LSM≥13 kPa), for those with significant fibrosis at baseline. Fibrosis regression was defined as transition to LSM<8 kPa, or to LSM<13 kPa for those with cirrhosis at baseline. MASLD was defined as hepatic steatosis (controlled attenuation parameter >248 dB/m) with at least one metabolic abnormality. A continuous-time multi-state Markov model was used to describe transitions across fibrosis states. Results: Among 1183 PWH included from three centres (25.2% with viral hepatitis coinfection), baseline prevalence of significant fibrosis and MASLD was 14.4% and 46.8%, respectively. During a median follow-up of 2.5 years (interquartile range 1.9-3.5) the incidence rate of fibrosis progression and regression was 2.8 (95% CI, 2.3-3.4) and 2.2 (95% CI, 1.9-2.6) per 100 person-years, respectively. In Markov model, weight gain increased the odds of fibrosis progression (odds ratio [OR] 3.11, 95% CI 1.59-6.08), whereas weight gain (OR 0.30, 95% CI 0.10-0.84) and male sex (OR 0.32, 95% CI 0.14-0.75) decreased the odds of fibrosis regression. On multivariable Cox regression analysis, predictors of fibrosis progression were weight gain (adjusted hazard ratio [aHR] 3.12, 95% CI 1.41-6.90) and MASLD (aHR 2.72, 95% CI 1.05-7.02). Conclusions: Fibrosis transitions are driven by metabolic health variables in PWH, independently of viral hepatitis coinfection and antiretroviral class therapy.

The effect of weight gain and metabolic dysfunction-associated steatotic liver disease on liver fibrosis progression and regression in people with HIV / Guaraldi, Giovanni; Milic, Jovana; Renzetti, Stefano; Motta, Federico; Cinque, Felice; Bischoff, Jenny; Desilani, Andrea; Conti, Jacopo; Medioli, Filippo; del Monte, Martina; Kablawi, Dana; Elgretli, Wesal; Calza, Stefano; Mussini, Cristina; Rockstroh, Juergen K.; Sebastiani, Giada. - In: AIDS. - ISSN 0269-9370. - (2024), pp. 1-21. [10.1097/qad.0000000000003903]

The effect of weight gain and metabolic dysfunction-associated steatotic liver disease on liver fibrosis progression and regression in people with HIV

Guaraldi, Giovanni;Motta, Federico;Conti, Jacopo;Medioli, Filippo;del Monte, Martina;Mussini, Cristina;
2024

Abstract

Objective: People with HIV (PWH) have high risk of liver fibrosis. We investigated the effect of weight gain and metabolic dysfunction-associated steatotic liver disease (MASLD) on liver fibrosis dynamics. Design: Multicenter cohort study. Methods: Fibrosis progression was defined as development of significant fibrosis (liver stiffness measurement [LSM]≥8 kPa), or transition to cirrhosis (LSM≥13 kPa), for those with significant fibrosis at baseline. Fibrosis regression was defined as transition to LSM<8 kPa, or to LSM<13 kPa for those with cirrhosis at baseline. MASLD was defined as hepatic steatosis (controlled attenuation parameter >248 dB/m) with at least one metabolic abnormality. A continuous-time multi-state Markov model was used to describe transitions across fibrosis states. Results: Among 1183 PWH included from three centres (25.2% with viral hepatitis coinfection), baseline prevalence of significant fibrosis and MASLD was 14.4% and 46.8%, respectively. During a median follow-up of 2.5 years (interquartile range 1.9-3.5) the incidence rate of fibrosis progression and regression was 2.8 (95% CI, 2.3-3.4) and 2.2 (95% CI, 1.9-2.6) per 100 person-years, respectively. In Markov model, weight gain increased the odds of fibrosis progression (odds ratio [OR] 3.11, 95% CI 1.59-6.08), whereas weight gain (OR 0.30, 95% CI 0.10-0.84) and male sex (OR 0.32, 95% CI 0.14-0.75) decreased the odds of fibrosis regression. On multivariable Cox regression analysis, predictors of fibrosis progression were weight gain (adjusted hazard ratio [aHR] 3.12, 95% CI 1.41-6.90) and MASLD (aHR 2.72, 95% CI 1.05-7.02). Conclusions: Fibrosis transitions are driven by metabolic health variables in PWH, independently of viral hepatitis coinfection and antiretroviral class therapy.
2024
1
21
The effect of weight gain and metabolic dysfunction-associated steatotic liver disease on liver fibrosis progression and regression in people with HIV / Guaraldi, Giovanni; Milic, Jovana; Renzetti, Stefano; Motta, Federico; Cinque, Felice; Bischoff, Jenny; Desilani, Andrea; Conti, Jacopo; Medioli, Filippo; del Monte, Martina; Kablawi, Dana; Elgretli, Wesal; Calza, Stefano; Mussini, Cristina; Rockstroh, Juergen K.; Sebastiani, Giada. - In: AIDS. - ISSN 0269-9370. - (2024), pp. 1-21. [10.1097/qad.0000000000003903]
Guaraldi, Giovanni; Milic, Jovana; Renzetti, Stefano; Motta, Federico; Cinque, Felice; Bischoff, Jenny; Desilani, Andrea; Conti, Jacopo; Medioli, Filippo; del Monte, Martina; Kablawi, Dana; Elgretli, Wesal; Calza, Stefano; Mussini, Cristina; Rockstroh, Juergen K.; Sebastiani, Giada
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1338690
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