Original article| Volume 110, P54-61, April 2023

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Prevalence of non-alcoholic fatty liver disease in a multicentre cohort of people living with HIV in Spain.

Published:February 08, 2023DOI:


      • Prevalence of NAFLD is high in this cohort of PLWH according to non-invasive methods.
      • PLWH exposed to integrase strand transfer inhibitors showed a lower risk for NAFLD.
      • PLWH with NAFLD exposed to thymidine analogues had a higher risk for significant fibrosis.
      • A lower risk for significant fibrosis was observed in PLWH with NAFLD exposed to NNRTIs.



      Non-alcoholic fatty liver disease (NAFLD) is one of the most important liver comorbidities in people living with HIV (PLWH). Factors that could lead to a higher prevalence of NAFLD or ease the onset of fibrosis are unclear.


      Cohort study of the Spanish HIV Research Network, which comprehends 46 hospitals and more than 15,000 PLWH. Primary objectives were to assess NAFLD prevalence and liver fibrosis according to hepatic steatosis index (HSI) and NAFLD fibrosis score, respectively. Factors associated with both were analysed.


      A total of 4798 PLWH were included of whom 1461 (30.5%) showed an HSI>36; these patients had higher risk for significant fibrosis (OR 1.91; 95%CI 1.11–3.28). Factors associated with NAFLD were body mass index (OR 2.05; 95%CI 1.94–2.16) and diabetes (OR 4.68; 95%CI 2.17–10.08), while exposure to integrase strand transfer inhibitors showed a lower risk (OR 0.78; 95%CI 0.62–0.97). In patients with HSI>36, being female (OR 7.33; 95%CI 1.34–40), age (OR 1.22; 95%CI 1.11–1.34), body mass index (OR 1.35; 95%CI 1.18–1.54) and exposure to thymidine analogues (OR 75.4, 95%CI 6.9–823.5) were associated with a higher risk of significant fibrosis. However, exposure to non-nucleoside reverse transcriptase inhibitors (OR 0.12, 95%CI 0.02–0.89) and time of exposure to protease inhibitors (OR 0.97, 95%CI 0.95–1) showed a lower risk.


      NAFLD prevalence was high in our cohort. Patients exposed to INSTI showed a lower risk of NAFLD. In patients with hepatic steatosis, exposure to thymidine analogues had 75-fold more risk of significant fibrosis while exposure to NNRTIs reduced this risk.


      List of abbreviations:

      AIDS (Acquired immunodeficiency syndrome), ALT (Alanine aminotransferase), ART (Antiretroviral treatment), ARV (Antiretroviral), AST (Aspartate aminotransferase), BMI (Body mass index), CoRIS (Cohort of the spanish HIV research network), HBV (Hepatitis B virus), HCV (Hepatitis C virus), HIV (Human immunodeficiency virus), HSI (Hepatic steatosis index), IFG (Impaired fasted glucose), INSTIs (integrase strand transfer inhibitors), MSM (men who have sex with men), NAFLD (non-alcoholic fatty liver disease), NFS (NAFLD fibrosis score), NNRTIs (non-nucleoside reverse transcriptase inhibitors), NRTIs (nucleos(t)ide reverse transcriptase inhibitors), PI (protease inhibitors), PLWH (people living with HIV)
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