Effect of hepatic steatosis and associated metabolic comorbidities on health-related quality of life in people living with HIV

Introduction Hepatic steatosis related to non-alcoholic fatty liver disease (NAFLD) is increasing globally. In people living with HIV (PLWH) risk factors of hepatic steatosis are increased. The impact of hepatic steatosis on outcomes and in particular health-related quality of life (HRQL) in PLWH remains unknown.

Aims The aim of this cross-sectional cohort study (FLASH, Prevalence of Advanced Fibrosis in Patients Living With HIV) was to determine the contribution of hepatic steatosis on HRQL in PLWH and to identify confounders on HRQL.

Methods A total of 245 PLWH were prospectively enrolled. Hepatic steatosis was assessed using vibration controlled transient elastography (VCTE) and defined as a controlled attenuation parameter (CAP) of≥ 275 dB/m. The analysis was performed between CAP< 275 and≥ 275 dB/m. The generic EQ-5D-5L questionnaire was used to determine differences in the HRQL. Univariable and multivariable linear regression models were applied to identify predictors with impaired HRQL in both groups.

Results In this cohort, 65% (n= 160) presented without and 35% (n= 85) with hepatic steatosis, of whom the majority had NAFLD (n= 65, 76.5%). The HRQL (UI-value) was significantly lower in PLWH and steatosis (0.86± 0.18) in comparison to no steatosis (0.92± 0.13). The most strongly affected dimensions were mobility (p= 0.016) and pain/discomfort (p= 0.012) in the steatosis group, and the dimension anxiety/depression was equally impaired in both groups (p= 0.629). Unemployment (p= 0.025) and waist circumference (p= 0.017) remained independent predictors of a poor HRQL in the steatosis subgroup. In turn, age (p= 0.045), female sex (p= 0.030), BMI (p= 0.010) and arterial hypertension (p= 0.025) were independent predictors of a low HRQL in the subgroup without steatosis.

Conclusion Hepatic steatosis and metabolic comorbidities negatively affect the HRQL. Addressing these factors may improve patient reported and liver-related outcomes in PLWH.

Publication History

Article published online:
19 August 2022