Aetiology and severity of liver disease in HIV positive patients with suspected NAFLD: lessons from a cohort with available liver biopsies.

BACKGROUND: Spectrum of liver injury among HIV positive people is wide; in particular prevalence of non-alcoholic fatty liver disease (NAFLD) seems to be higher compared to HIV-negative people.

METHODS: We retrospectively evaluated all liver biopsies performed at Royal Free Hospital from 2000 to 2017 in HIV mono-infected patients with abnormal transaminases, in order to assess the underlying cause of liver disease and to characterize the extent of fibrosis. We furthermore evaluated the diagnostic accuracy of FIB4 and Fibroscan™ as non-invasive tools for fibrosis assessment.

RESULTS: 97 patients were included. Most common histological findings were NAFLD (28%), non-specific changes (26%) and normal histology (13%). 20% patients had significant fibrosis, 11% had advanced fibrosis. FIB4, at a cut-off of 1.3, had a specificity of 82% and NPV of 95% for exclusion of advanced fibrosis. Fibroscan was available in 28% patients and 33% had a liver stiffness ≥7.5 kPa. Fibroscan showed a specificity of 77% and NPV of 94% for exclusion of significant fibrosis. Among patients with NAFLD (n=27), 18% had advanced fibrosis while the majority (56%) did not have any fibrosis. The NPV of FIB4 for advanced fibrosis in these patients was 93%.

CONCLUSIONS: Among HIV positive patients with elevated transaminases, a surprisingly high number of patients had non-significant changes or even normal histological findings. The prevalence of NAFLD was lower than reported in other series. Use of non-invasive tools with a high NPV for significant fibrosis can help reduce the number of required biopsies.