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Clin Infect Dis. 2019 May 25. pii: ciz435. doi: 10.1093/cid/ciz435. [Epub ahead of print]

Natural course of NAFLD and type 2 diabetes in HIV-positive subjects with and without combination antiretroviral therapy (cART)-associated lipodystrophy: a 16-year follow-up study.

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Minerva Foundation Institute for Medical Research, Helsinki, Finland.
Department of Medicine, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland.
Infectious Diseases, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.



Abnormal glucose metabolism and non-alcoholic fatty liver disease (NAFLD) are common in HIV-positive (HIV+) subjects but longitudinal data are lacking. We determined the natural course of NAFLD (liver fat, LFAT) and type 2 diabetes (T2DM) in HIV+ subjects with and without lipodystrophy (LD) during a 16-year longitudinal study.


LFAT by proton magnetic resonance spectroscopy (1H-MRS), and clinical characteristics were measured in 41 HIV+ subjects at baseline and after 16 years. Liver fibrosis was estimated by measuring liver stiffness using transient elastography (TE) and magnetic resonance elastography (MRE) at 16 years. We also longitudinally studied 28 healthy control subjects.


During follow-up, the HIV+ group gained more body fat (8.6±0.7%) than the control subjects (4.5±0.6%, p<0.001). Features of insulin resistance (fasting glucose, insulin and HOMA-IR) increased significantly in the HIV+ but not the control subjects. A significant proportion (20%, p<0.01 vs. 0% at baseline) of the HIV+ but none of the control subjects developed T2DM. LFAT was significantly higher at baseline in the LD+ (4.3, 1.9-11.8) than the LD- (1.0, 0.5-1.5; p<0.001) HIV+ subjects. LFAT remained stable during follow-up in all groups. At follow-up, liver stiffness measured with TE was similar between all HIV, LD+, and LD- and control subjects, and between the LD+ and LD- subjects measured with MRE. Advanced fibrosis by MRE was observed in 3 of LD+ and none of LD- subjects.


During 16-years of follow-up, progression of NAFLD is rare compared to development of T2DM in HIV+ subjects.


elastography; glucose metabolism; human immunodeficiency virus; liver fibrosis; magnetic resonance ; non-alcoholic fatty liver disease


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