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"Endocrine NAFLD": a hormonocentric perspective of Non-Alcoholic Liver Disease (NAFLD) pathogenesis in HIV-infected patients

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Journal of the International AIDS Society200811 (Suppl 1) :P140

https://doi.org/10.1186/1758-2652-11-S1-P140

  • Published:

Keywords

  • Waist Circumference
  • Hypogonadism
  • Endocrine System
  • Thyroid Dysfunction
  • Hypopituitarism

Purpose of the study

We assessed endocrine system involvement in a multifactorial pathogenesis hypothesis of NAFLD in HIV-infected patients.

Methods

Cross-sectional observational study including all consecutive HIV-infected patients seen at a metabolic clinic who were screened for diabetes, thyroid dysfunction, male hypogonadism, female menopause, hypopituitarism. NAFLD was defined by liver-spleen attenuation values of ≤1.1 on computed tomography.

Summary of results

225 patients were included. (Table 1.)

Table 1

 

NAFLD+

NAFLD-

P-value

Male, n (%)

71 (85.54)

92 (64.79)

< .001*

Age, yrs

48.43 ± 8.16

48.04 ± 8.84

.74**

CDC C, n (%)

41 (28.87)

21 (25.30)

.14*

ALT/AST

1.46 ± 0.52

1.12 ± 0.38

< .001 **

Waist, cm

   

Total

90.26 ± 9.24

83.87 ± 9.27

< .001 **

Men

90.27 ± 8.41

85.13 ± 8.42

< .001 **

Women

90.18 ± 14.00

81.57 ± 10.35

.022 **

NRTI Cumulative Exp, months

124.16 ± 44.86

109.85 ± 49.16

.033 **

NNRTI Cumulative Exp, months

41.94 ± 30.43

35.54 ± 30.13

.15 **

PI Cumulative Exp, months

61.34 ± 36.87

60 ± 39.73

.81 **

Hormones

   

TSH

1.93 ± 1.21

2.20 ± 1.57

.19 **

T4

11.01 ± 1.48

10.71 ± 1.38

.14 **

Insulin, median (IQR)

17.1 (11.65; 22.8)

10.2 (7.4; 16.5)

< .001§

LH, median (IQR) n = 60

4.6 (2.8; 9.5)

6.2 (4; 19.2)

.38§

FSH, (IQR) n = 60

4 (2.2; 8.9)

6.3 (4; 20.1)

.21§

17-beta-estradiol, (IQR) n = 60

81 (27; 104)

89 (38; 145)

.42§

Total testosterone, (IQR) n = 152

483 (372; 583)

433 (343; 531)

.11§

Free testosterone, (IQR) n = 152

13.2 (9.6; 16.8)

13 (8.8; 16.3)

.64§

GH, (IQR)

.11 (.06; .35)

.28 (.08; 1.04)

.003§

IGF1

132.32 ± 57.65

141.75 ± 61.33

.26 **

IGFBP3, (IQR)

3210 (2240; 4280)

3382 (2050; 4297)

.90§

Endocrine syndromes

   

Hypothyroidism TSH ≥3.5, n (%)

7 (8.43)

18 (12.68)

.11*

Diabetes Fasting glucose ≥126 mg/dL

20 (24.10)

17 (11.97)

.018*

MenopauseLH and FSH > 20 ng/mL and 17 beta-estradiol < 40 pg/mL n = 62

2 (16.67)

7 (14)

.81*

Hypogonadism testosterone < 200 ng/dL n = 163

3 (3.26)

1 (1.41)

.29*

Hypopituitarism IGF-1 < 73 pg/mL and IGFBP3 < 1157 pg/mL

13 (15.66)

25 (17.61)

.70*

* chi-squared test; ** T-test; §Mann-Whitney test.

We included endocrine variables (but not sex hormones) and known independent predicting variables (sex, waist circumference, ALT/AST, NRTI cumulative exposure) in a backward stepwise multivariate logistic regression analysis. Independent variables associated with NAFLD were NRTI cumulative exposure (OR = 1.11 per year; CI 1.01–1.20), ALT/AST (OR = 3.97; CI 1.78–8.87), waist circumference (OR = 1.06; CI 1.03–1.11). When including sex hormones in different gender groups insulin increased predictive value in female only (OR = 1.18; CI 1.03, 1.34).

Conclusion

Homeostasis of glucose appears the only endocrine system associated with NAFLD.

Authors’ Affiliations

(1)
University of Modena and Reggio Emilia, Modena, Italy

Copyright

© Stentarelli et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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