Abstract
Background
Recent studies have shown increased weight gain and visceral adiposity in people living with HIV (PLWH) treated with integrase strand transfer inhibitors (INSTI), mostly among women, Blacks and Hispanics. A potential association of INSTI with hepatic steatosis (HS)—which has been associated with increased atherosclerotic cardiovascular disease (ASCVD) risk in the general population—has never been evaluated. We sought to evaluate the prevalence of HS among PLWH on ART, its association with race/ethnicity and INSTI exposure and its association with ASCVD risk.
Methods
All patients on stable ART in a large urban clinic were included in the analysis. We calculated Hepatic Steatosis Index (HSI = 8 × (ALT/AST ratio)+BMI (+2, if female; +2, if diabetes mellitus) in all patients and Controlled Attenuation Parameter (CAP) score in a subset that underwent transient elastography. The effects of ART class, race and ethnicity on HSI and CAP were examined using linear regression models adjusting for age. We also correlated HSI with CAP and with ASCVD risk score.
Results
Among the 3122 patients analyzed, 84.6% were male, 45.1% Black (B), 22.5% Hispanic (H), and 30.0% non-Hispanic Whites (NHW). Mean age was 42 years. ART regimens were INSTI-based (n = 1777), PI (n = 723) or NNRTI (n = 302). A subset of 77 patients underwent transient elastography. There was no significant difference in mean BMI between INSTI (27.87), PI (27.70) and NNRTI (28.26) recipients (P = 0.49). However, HSI was lower for PI (35.99) than for INSTI (36.73) and NNRTI (37.46) groups (P = 0.02). Age is also significantly associated with his (P < 0.01). Mean HSI was higher for H (37.54) than non-Hispanics (36.56 for B and 36.19 for NHW); P = 0.001. HSI was highly correlated with ASCVD risk score (R=0.1; P < 0.001). There was also a strong correlation between HSI and CAP (R=0.45; P < 0.001), and a trend toward high CAP for H vs. B and W (P = 0.11).
Conclusion
HSI increased with age and was significantly associated with ASCVD risk score, suggesting that HS in PLWH might predict higher ASCVD risk. Hispanics had higher HSI and higher CAP than Blacks and Whites. We did not observe an increased BMI or HS with INSTI exposure in this cohort. PI use was associated with lower risk of HS.
Disclosures
All authors: No reported disclosures.
Session: 44. HIV Complications: Cardiovascular, Metabolic, and Other Complications
Thursday, October 3, 2019: 12:15 PM