Nonalcoholic fatty liver disease and hepatic fibrosis among perinatally HIV-monoinfected Asian adolescents receiving antiretroviral therapy

Autoři: Tavitiya Sudjaritruk aff001;  Torsak Bunupuradah aff003;  Linda Aurpibul aff002;  Pope Kosalaraksa aff004;  Nia Kurniati aff005;  Jiratchaya Sophonphan aff003;  Panruethai Trinavarat aff006;  Pannee Visrutaratna aff007;  Jiraporn Srinakarin aff008;  Nataruks Chaijitraruch aff009;  Thanyawee Puthanakit aff003
Působiště autorů: Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand aff001;  Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand aff002;  HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand aff003;  Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand aff004;  Department of Child Health, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia aff005;  Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand aff006;  Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand aff007;  Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand aff008;  Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand aff009;  Center of Excellence in Pediatric Infectious Diseases and Vaccine, Chulalongkorn University, Bangkok, Thailand aff010
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226375


To assess and compare the prevalence of persistent hepatic abnormalities, including nonalcoholic fatty liver disease (NAFLD) and/or hepatic fibrosis, among perinatally HIV-monoinfected Asian adolescents with history of abnormal hepatic enzymes to those without, using noninvasive diagnostic tools. A multicenter cohort study was conducted in Thailand and Indonesia. Adolescents aged 10–25 years who were on antiretroviral treatment (ART), had virologic suppression (HIV RNA<400 copies/mL within the past 6 months), and had no history of chronic hepatitis B/C infection were enrolled. Participants were pre-classified into 2 subgroups (1:1 ratio) as participants with history of elevated versus normal aminotransferase enzymes. NAFLD was defined as hepatic steatosis (any severity) evaluated by liver ultrasonography. Significant hepatic fibrosis was defined as liver stiffness ≥7.4 kPa evaluated by transient elastography. Participants who met the criteria for protocol-defined NAFLD and/or hepatic fibrosis were re-assessed to evaluate disease progression (persistent versus transient hepatic abnormalities) at one year later. Of 120 participants, 62 (51.7%) were male, 7 (5.8%) had central obesity, and 19 (15.8%) had insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] >3.16). At enrollment, the median age and duration of ART (IQR) were 17.0 (14.6–19.2) years and 10.5 (7.1–12.0) years, respectively. Persistent hepatic abnormalities were identified in 5/60 participants listed in the group having history of elevated aminotransferases, corresponding to the prevalence of 8.3% (95% CI: 2.8–18.4%), whereas none (0/60) were among the group having history of normal hepatic enzymes. All 5 participants had persistent aminotransferase elevation (≥2 episodes within the past 12 months). Baseline alanine aminotransferase (ALT) >30 U/L (adjusted odds ratio [aOR]: 29.1; 95% CI: 1.7–511.8), and HOMA-IR >3.16 (aOR: 17.9; 95% CI: 1.1–289.7) were independently associated with persistent hepatic abnormalities. Among perinatally HIV-monoinfected Asian adolescents with history of elevated aminotransferase enzymes, persistent hepatic abnormalities are not uncommon. Screening for liver complications by noninvasive diagnostic tools might be considered in at risk individuals, including those with persistent ALT elevation and insulin resistance.

Klíčová slova:

Aminotransferases – Fatty liver – Fibrosis – Liver fibrosis – Obesity – Steatosis – Ultrasound imaging


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