Association between visceral abdominal fat accumulation and severity of liver fibrosis in nondiabetic individuals coinfected by HIV and HCV.

Our primary objective was to assess the independent association between Liver fibrosis (LF) and Abdominal fat accumulation (AFA) and Fatty liver disease (FLD). We also aimed to determine the diagnostic accuracy of AFA and FLD for the prediction of cirrhosis measured using unenhanced low-dose computed tomography (CT).

METHODS: Cross-sectional study in stable HIV/HCV-coinfected patients with active HCV replication. CT was used to quantify fat content in segments III and VI of the liver and AFA. Transient elastometry was used to stage LF. Multivariate logistic regression, receiver operating characteristic curve analysis, and linear mixed models analysis were applied.

RESULTS: 115 HIV/HCV-coinfected patients were included Cirrhosis was detected in 20.8% (24 patients). There was a high correlation between anthropometric characteristics and radiological variables. The factors independently associated with cirrhosis were albumin concentration (OR, 0.69; 95%CI, 0.58-0.83; p<0.0001) and Visceral fat accumulation (FA) (OR, 1.02; 95%CI, 1.01-1.04; p=0.0003). Multinomial analysis showed that VFA was the factor independently associated with stage F2 (OR, 1.02; 95%CI, 1.0-1.03; p<0.005) and albumin concentration with stage F3 (OR, 0.75; 95%CI, 0.64-0.89; p<0.001). VFA was the only radiological variable with an area under the curve >0.7 for the prediction of cirrhosis. There was no inter- or intra-observer variability in the measurement of AFA; however, high inter-observer variability was recorded in the measurement of FLD.

CONCLUSIONS: The association of VFA with cirrhosis, the high reproducibility of CT for the measurement of VFA and the ability of VFA to predict cirrhosis make CT a suitable technique for identifying HIV/HCV-coinfected patients for closer surveillance.