Prevalence and factors associated with liver steatosis as measured by transient elastography with controlled attenuation parameter in HIV-infected patients

Objective:To assess the prevalence and factors associated with significant hepatic steatosis (SHS, steatosis involving 10% hepatocytes) in HIV-infected patients.Design:A prospective, cross-sectional study.Methods:Five hundred and five HIV-infected patients were included in this study. All patients underwent a transient elastography examination with the controlled attenuation parameter (CAP). SHS was defined using the previously identified CAP cut-off of 238dB/m. We analysed the associations between SHS and demographics, metabolic data, coinfections and drug therapy.Results:SHS was detected in 201 (40%) patients. Individuals with and without plasma HIV RNA of 50copies/ml or less presented SHS in 168 (42%) and 33 (31%) cases, respectively (P=0.030). Patients with SHS compared with those without SHS presented higher median (IQR) BMI [BMI, 25.6 (22.5-28) vs. 22.3 (20.3-24.2) kg/m(2); P<10(-6)], DBP [79 (72-85) vs. 74 (68-81) mmHg; P=0.0001], fasting plasma glucose [95 (87-106) vs. 91 (84-97) mg/dl; P=0.002] and triglycerides [128 (92-189) vs. 109 (80-167) mg/dl; P=0.002], and lower HDL cholesterol [44 (37-54) vs. 48 (40-59), mg/dl; P=0.004]. In multivariate analysis, the only factor associated with SHS was BMI [per unit increase, adjusted odds ratio (95% confidence interval) 1.34 (1.22-1-47); P<10(-6)].Conclusion:SHS measured by CAP is highly prevalent among HIV-infected patients. High BMI is the main predictor of SHS in this setting.