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BMC Gastroenterol. 2019 Apr 15;19(1):52. doi: 10.1186/s12876-019-0969-1.

Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people.

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Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3910 Powelton Ave 4nd Floor, Ste. 411F, Philadelphia, PA, 19104, USA.
Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA, and VA Connecticut Healthcare, West Haven, CT, USA.
Department of Medicine, Weill Cornell Medical College, Ar-Rayyan, Qatar.
Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
John Bell Health Center, Philadelphia FIGHT, Philadelphia, PA, USA.
Department of Medicine and Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.



Hepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection. We compared the prevalence and severity of hepatic steatosis between HIV-infected (HIV+) and uninfected persons and identified factors associated with greater steatosis severity within both groups.


We performed a cross-sectional study among participants without cardiovascular disease who participated in a substudy of the Veterans Aging Cohort Study. Hepatic steatosis was defined by noncontrast computed tomography (CT) liver-to-spleen (L/S) attenuation ratio < 1.0. Multivariable linear regression was used to: 1) evaluate the association between HIV infection and severity of hepatic steatosis, as measured by absolute liver attenuation, and 2) identify factors associated with greater severity of steatosis, by HIV status.


Among 268 participants (median age, 55 years; 99% male; 79% black; 23% obese; 64% HIV+ [91% on antiretroviral therapy]), the overall prevalence of steatosis was 7.8% and was similar between HIV+ and uninfected individuals (13 [7.6%] versus 8 [8.2%], respectively; p = 0.85). Participants with HIV, the majority of whom received antiretroviral therapy, had a higher mean absolute liver attenuation (mean difference, 5.68 Hounsfield units; p < 0.001), correlating with lesser hepatic steatosis severity, compared to uninfected participants. After adjusting for covariates, only advanced hepatic fibrosis was associated with greater severity of steatosis in HIV+ persons (p = 0.03) and uninfected individuals (p < 0.001).


In this sample of participants without cardiovascular disease, the prevalence of hepatic steatosis by noncontrast abdominal CT was not different by HIV status. Increasing severity of steatosis was independently associated with advanced hepatic fibrosis in both groups.


HIV; Hepatic steatosis; Liver fibrosis

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