Prevalence and influencing factors of liver injury in naïve patients with HIV/AIDS in Nanjing from 2005 to 2022: Cross-sectional study

To investigate the prevalence of liver injury and the factors influencing severe liver injury in antiretroviral therapy (ART)-naïve patients with human immunodeficiency virus (HIV) infection. ART-naïve HIV-1 infected patients who visited the outpatient department of the Infection Department of the Second Hospital of Nanjing between January 1, 2005, and May 31, 2022, were included in the study. The clinical data of patients with baseline liver injury were retrospectively collected. Liver injury was classified as grade 1, 2, 3, or 4 according to the severity scale of adverse events in adults and children with acquired immunodeficiency syndrome (AIDS), based on the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL). A total of 982 patients were included in the analysis. The overall prevalence of liver injury (grades 1-4) was 19.3% (982/5099), with grade 1 liver injury (75.9%, 745/982) be the most common. Multivariate logistic regression analysis revealed that high-density lipoprotein cholesterol (HDL-C) was a protective factor against severe liver injury (odds ratio [OR] = 0.28, 95% CI = 0.08-0.99, P = .048). Conversely, hepatitis B virus (HBV) infection (OR = 4.02, 95% CI = 1.82-8.88, P = .001) elevated gamma-glutamyl transpeptidase (GGT, OR = 1.04, 95% CI = 1.01-1.06, P = .004), and elevated levels of lactic dehydrogenase (LDH, OR = 1.03, 95% CI = 1.01-1.04, P = .002) were identified as independent risk factors for severe liver injury in newly treated HIV/AIDS patients. Liver injury is prevalent among HIV/AIDS patients who have not initiated ART. HDL-C, HBV infection, GGT, and LDH are significant factors influencing the severity of liver injury.