Uncovering the NAFLD burden in people living with HIV from high‐ and middle‐income nations: a meta‐analysis with a data gap from Subsaharan Africa

Author:

Manzano‐Nunez Ramiro123,Rivera‐Esteban Jesús123,Navarro Jordi24,Bañares Juan12,Sena Elena12,Schattenberg Jörn M.5,Lazarus Jeffrey V.678,Curran Adria24,Pericàs Juan M.129

Affiliation:

1. Liver Unit, Internal Medicine Department Vall d'Hebron University Hospital Barcelona Spain

2. Vall d'Hebron Institute for Research Barcelona Spain

3. Faculty of Medicine Universitat Autònoma de Barcelona Barcelona Spain

4. HIV Unit, Infectious Disease Department Vall d'Hebron University Hospital Barcelona Spain

5. Metabolic Liver Disease Research Program I. Department of Medicine University Medical Center of the Johannes Gutenberg‐University Mainz Germany

6. Barcelona Institute for Global Health (ISGlobal) Hospital Clínic University of Barcelona Barcelona Spain

7. Faculty of Medicine and Health Sciences University of Barcelona Barcelona Spain

8. CUNY Graduate School of Public Health and Health Policy New York New York USA

9. Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd) Madrid Spain

Abstract

AbstractIntroductionNon‐alcoholic fatty liver disease (NAFLD) has become a significant concern among people living with HIV (PLHIV), albeit its burden remains unclear. The primary objective of this systematic review (SR) and meta‐analysis (MA) was to estimate the prevalence of NAFLD and significant fibrosis in PLHIV. The secondary objective was to determine the risk factors for NAFLD among PLHIV.MethodsWe searched MEDLINE and Scopus from inception to 30 December 2022 for peer‐reviewed studies that included PLHIV and reported the prevalence of NAFLD. MA of proportions was used to estimate the pooled prevalence of NAFLD and significant fibrosis. MA of pre‐calculated effect estimates examined risk factors for NAFLD in PLHIV.ResultsWe included 24 articles published between 2009 and 2022, encompassing 6326 PLHIV. The pooled prevalence of NAFLD was 38% (95% CI: 31–45%) with high heterogeneity (I2 = 96.3%). The pooled prevalence of significant fibrosis was 13% (95% CI: 8–18%) with high heterogeneity (I2 = 92.09%). Subgroup analyses showed a NAFLD prevalence of 40% (95% CI: 24–57%) in the United States, 33% (95% CI: 31–36) in Asia, 42% (95% CI: 24–61%) in Europe and 33% (95% CI: 29–37) in South America. When stratifying by income level, NAFLD was 39% (95% CI: 31–48) prevalent in PLHIV from high‐income economies and 34% in both upper‐middle‐income (95% CI: 31–37%) and lower‐middle‐income economies (95% CI: 28–41%). Higher body mass index (BMI) (OR = 1.32, 95% CI: 1.13–1.55; I2 = 89.9%), increasing triglycerides (OR = 1.48, 95% CI: 1.22–2.79; I2 = 27.2%) and dyslipidaemia (OR = 1.89, 95% CI: 1.32–2.71; I2 = 15.5%) were all associated with higher risk‐adjusted odds of NAFLD in PLHIV.DiscussionThe burden of NAFLD and significant fibrosis in PLHIV is significant. Therefore, targeted efforts to screen and diagnose NAFLD in this population are needed. Health services for PLHIV could include ways to target NAFLD risk factors, screen for liver disease and implement interventions to treat those with significant fibrosis or more advanced stages of liver disease. Taking no action to address NAFLD in PLHIV should not be an option.ConclusionsThis SR and MA found a 38% NAFLD and 13% significant fibrosis prevalence in PLHIV. Increasing triglyceride levels, higher BMI values and dyslipidaemia were associated with higher risk‐adjusted odds of NAFLD among PLHIV.

Publisher

Wiley

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health

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