Liver steatosis and non-alcoholic fatty liver disease with fibrosis are predictors of frailty in people living with HIV

OBJECTIVE:The aim was to investigate the contribution of liver steatosis and significant fibrosis alone and in association (NAFLD with fibrosis) to frailty as a measure of biological age in people living with HIV (PLWH). DESIGN:This was a cross-sectional study of consecutive patients attending Modena HIV Metabolic Clinic in 2018-2019. METHODS:Patients with hazardous alcohol intake and viral hepatitis co-infection were excluded. Liver steatosis was diagnosed by controlled attenuation parameter (CAP), while liver fibrosis was diagnosed by liver stiffness measurement (LSM). NAFLD was defined as presence of liver steatosis (CAP≥248), while significant liver fibrosis or cirrhosis (stage ≥F2) as LSM≥7.1 kPa. Frailty was assessed using a 36-Item frailty index (FI). Logistic regression was used to explore predictors of frailty using steatosis and fibrosis as covariates. RESULTS:We analyzed 707 PLWH (mean age 53.5 years, 76.2% males, median CD4 700 μL, 98.7% with undetectable HIV RNA). NAFLD with fibrosis was present in 10.2%; 18.9% and 3.9% of patients were classified as frail and most-frail, respectively. Univariate analysis demonstrated that neurocognitive impairment (OR = 5.1, 1.6–15), vitamin D insufficiency (OR = 1.94, 1.2–3.2), obesity (OR = 8.1, 4.4–14.6), diabetes (OR = 3.2, 1.9–5.6) and osteoporosis (OR = 0.37, 0.16–0.76) were significantly associated with NAFLD with fibrosis. Predictors of FI includedsteatosis (OR = 2.1, 1.3–3.5), fibrosis (OR = 2, 1–3.7), NAFLD with fibrosis (OR = 9.2, 5.2–16.8), diabetes (OR = 1.7, 1–2.7) and multimorbidity (OR = 2.5, 1.5–4). CONCLUSION:Liver steatosis and NAFLD with fibrosis were associated with frailty. NAFLD with fibrosis exceeded multimorbidity in the prediction of frailty, suggesting the former as an indicator of metabolic age in PLWH.