5 Questions About Hepatic Steatosis in People With HIV

Hepatic steatosis (HS) may predict higher atherosclerotic cardiovascular disease (ASCVD) risk among people with HIV, according to a recent study.¹ The research team reached this conclusion after finding an association between Hepatic Steatosis Index (HSI) and ASCVD risk score.

Moreover, the researchers found that Hispanics had higher HSI and higher Controlled Attenuation Parameter scores than blacks and whites.

To find out more about these findings, Gastroenterology Consultant reached out to lead author Roger Bedimo, MD, MS, who is chief of the Infectious Diseases Section at the VA North Texas Health Care System and professor of medicine at UT Southwestern Medical Center in Dallas, Texas.

GASTRO CON: Why has the association between integrase strand transfer inhibitors with hepatic steatosis never been evaluated among people with HIV?

Roger Bedimo: Favorable lipoprotein changes associated with integrase strand transfer inhibitors have been very reassuring. It was the unexpected finding of increased weight gain in a significant subset of patients exposed to this class of medications that have led to a search for potential metabolic risk, including hepatic steatosis.

GASTRO CON: What prompted you to conduct the study?

RB: While not yet confirmed, emerging data suggests central distribution of the integrase inhibitor-associated weight gain.  Should this be visceral fat, it would likely be associated to hepatic adiposity. 

GASTRO CON: What are the most important findings from your research?

RB: That among people living with HIV, hepatic steatosis is associated with increased cardiovascular risk.  This suggests that we should place increased focus on understanding its determinants and how it can be mitigated.

Per our analysis, there are demographic predictors (age, race/ethnicity) of hepatic steatosis. It might in turn predict increased cardiovascular risk in people with HIV. However, we cannot conclude on the association of specific antiretroviral classes like integrase inhibitors because we did not model cumulative exposure. 

GASTRO CON: What are the clinical implications of your study?

RB: Among people living with HIV, hepatic steatosis is common and could be associated with increased cardiovascular risk. As the Hepatic Steatosis Index was very well correlated with less readily available procedures like Fibroscan® with controlled attenuation parameter, it should be used by clinicians to screen for hepatic steatosis in people living with HIV

GASTRO CON: What are the next steps of your research?

RB: We are currently modeling cumulative exposure to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors to see if this predicts hepatic steatosis.

We are also examining whether weight gain from integrase inhibitors is correlated with hepatic steatosis.

Reference:

1. Bedimo R, Gillman J, Ayers C, et al. Hepatic steatosis in people living with HIV—effect of sex and race/ethnicity [abstract 347]. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. https://www.eventscribe.com/2019/IDWeek/fsPopup.asp?Mode=posterinfo&PosterID=228722.