Patients with HIV and NAFLD at an Increased Risk of Cardiovascular Disease

New data presented at the American College of Gastroenterology (ACG) 2022 annual meeting in Charlotte shows patients with HIV and non-alcoholic fatty liver disease (NAFLD) are at an increased risk of a number of cardiovascular disease.

A team, led by Arukumar Krishnan, MBBS, West Virginia University School of Medicine, explored data on cardiovascular disease among patients with HIV and NAFLD compared to patients with HIV without NAFLD.

NAFLD and HIV

As many as 40% of patients with HIV also have NAFLD, according to previous research. Cardiovascular disease is another growing concern in this population.

However, the link between NAFLD and cardiovascular disease is not yet known, especially the relationship between NAFLD and cardiovascular disease among patients with HIV.

In the population-based, multicenter, retrospective cohort, the investigators identified adult patients with HIV using the TriNetX platform. The investigators then identified patients diagnosed with NAFLD after excluding patients with other chronic liver disease etiologies. In addition, patients without NAFLD were included as a control group.

Examining Patients

The team performed a 1:1 propensity score match for demographics, body mass index (BMI), and comorbidities.

The investigators sought main outcomes of major cardiovascular disease events.

The study included 151,868 patients with HIV, 4969 of which had NAFLD. There were also 146,899 patients with HIV without NAFLD included as the control group.

Following the propensity score matching, the investigators matched patients with HIV and NAFLD and patients with HIV without NAFLD (n = 4463). The results show patients with NAFLD were more likely to have comorbidities, including diabetes, hypertension, chronic respiratory disease, hypothyroidism, chronic kidney disease, sleep apnea, and hyperlipidemia.

The Risk of Cardiovascular Disease

After conducting an adjusted analysis, the team found the risk of ischemic heart disease (HR, 2.14; 95% CI, 1.58-2.90), acute myocardial infarction (HR, 1.80; 95% CI, 1.01-3.20), heart failure (HR(HR 3.53, 95% CI 2.13-5.87), atherosclerosis (HR 1.96, 95% CI 1.12-3.45), composite myocardial infarction (HR, 1.80; 95% CI, 1.01-3.20), cerebrovascular disease (HR, 1.85, 95% CI, 1.11-3.10), stroke (HR, 1.87; 95% CI, 1.31-2.70), arterial fibrillation (HR, 2.25; 95% CI, 1.39-3.63), and coronary artery disease-related procedures (HR, 1.89; 95% CI, 1.69-2.13) compared to patients without NAFLD.

“In this large, propensity score-matched multicenter study, CVD was independently associated with prevalent NAFLD after controlling for traditional CVD risk factors in PLWH compared to those without NAFLD. NAFLD is common in PLWH and is associated with increased CV risk as in the general population,” the authors wrote.

The study, “A0488 - Nonalcoholic Fatty Liver Disease and Risk of Cardiovascular Diseases Among Persons With HIV: A Large Multicenter Study,” was published online by ACG.