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July 8, 2008
Fatty Liver Common in Patients With Metabolic Problems
Nonalcoholic Fatty Liver Disease (NAFLD)—a condition marked by chronic liver inflammation in people who drink little or no alcohol and who do not have viral hepatitis—was found in more than a third of HIV-positive patients being treated for metabolic disorders, say the authors of a study published in the July 15 issue of Clinical Infectious Diseases. Use of nucleoside reverse transcriptase inhibitors (NRTIs) was associated with an increased risk for NAFLD.
NAFLD can lead to permanent damage of the liver, liver failure and clogging of the arteries. This last element, atherosclerosis, is of particular interest to researchers, who believe that NAFLD may be an important early indicator of cardiovascular disease. Cardiovascular disease is a growing concern in HIV disease, as people with HIV have been found to have an increased risk of heart attacks. Both NAFLD and cardiovascular disease are more common in HIV-negative people with metabolic syndrome, a cluster of symptoms that include unhealthy changes to cholesterol levels and blood sugar, and the accumulation of fat in the gut area.
To determine the prevalence and risk factors of NAFLD in people with HIV, Giovanni Guaraldi, MD, of the University of Modena and Reggio Emilia School of Medicine, in Modena, Italy, and his colleagues enrolled 225 HIV-positive patients who had been referred to a clinic for metabolic disorders. Seventy-two percent of the patients were male, the average age was 48 and nearly two thirds were smokers. A diagnosis of NAFLD was made by interpreting the results of a computed axial tomography (CT) scan of the liver and spleen.
Guaraldi’s team diagnosed 37 percent of the patients with NAFLD, a far higher rate than was anticipated. The team also found that use of NRTIs was an independent risk factor for diagnosis of NAFLD, with an increased risk of 11 percent for each year that a person had been taking NRTIs.
The authors conclude that NAFLD may greatly increase the risk of cardiovascular disease in HIV-positive people, notably those with other risk factors including obesity, smoking, high cholesterol and diabetes.
