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Risk factors for advanced liver fibrosis in HIV-infected individuals: role of the metabolic syndrome


Liver damage in HIV patients may result from multiple factors. The availability of reliable non-invasive tools to measure liver fibrosis, such as transient elastometry (FibroScan), has permitted the screening of large populations.


Cross-sectional study of all HIV outpatients who underwent examination by FibroScan at one HIV reference clinic since 2005. Advanced liver fibrosis (ALF) was defined as hepatic stiffness >9.5 kiloPascals, which corresponds to Metavir stages F3–F4 in the liver biopsy. Main demographics, alcohol abuse, antiretroviral exposure, biochemistry, HOMA index, immune and viral parameters, and hepatitis B or C status were evaluated.

Summary of results

A total of 681 consecutive HIV patients (64% injecting drug users; mean age 43 years; 78% male; 77% on antiretroviral therapy) had a valid FibroScan evaluation. Main characteristics: mean CD4 count 524 (309) cells/mm3, plasma HIV-RNA <50 cp/mL 72%, HBsAg+ 8.5%, HCV-RNA+ 60%, mean BMI 23.6 (3.9) kg/m2, past and current alcohol abuse (>60 g/d) 33% and 10%, respectively. ALF was diagnosed in 215 (32%).

In the univariate analysis, significant differences were found between patients with and without ALF for mean age (44 vs. 42 years), risk behaviour (IDU 81 vs. 54%, MSM 11 vs. 33%, heterosex 6 vs. 12%), past alcohol abuse (50 vs. 26%), mean CD4+ count (469 vs. 550 cells/mm3), HCV-RNA+ (77 vs 52%), ALT >50 IU/L (29 vs 9%), mean plasma glucose (127 vs. 116 mg/dL), triglycerides (223 vs. 172 mg/dL), and total cholesterol (177 vs. 188 mg/dL), HOMA index (4.5 vs. 3.2), past exposure to ddI +/- d4T (51 vs. 40%), and mean months on NVP (11 vs. 16), LPV (13 vs. 8), atazanavir (7 vs. 5), tenofovir (21 vs. 18) as well as any antiretroviral (85 vs. 78).

In a multivariate model (OR, 95% CI), older age (1.08, 1.04–1.13), past alcohol abuse (2.62, 1.60–4.28), exposure to ddI and/or d4T (1.94, 1.20–3.16), higher HOMA index (1.25, 1.04–1.51) and elevated ALT (1.05, 1.03–1.06) were all independently associated with ALF; in contrast, chronic hepatitis B or C were no longer associated with ALF.


Former alcohol abuse and non-alcoholic steatohepatitis as a result of insulin resistance and/or exposure to dideoxy-nucleosides represent an emerging cause of ALF in HIV patients.


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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Blanco, F., Barreiro, P., Ryan, P. et al. Risk factors for advanced liver fibrosis in HIV-infected individuals: role of the metabolic syndrome. JIAS 11 (Suppl 1), P137 (2008).

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