The impact of cART on hepatic steatosis and fibrosis in treatment-naïve PLwHIV: A prospective cohort study

BackgroundWe aimed to determine the effect of combined antiretroviral therapy (cART) on hepatic steatosis and fibrosis in people living with human immunodeficiency virus (PLwHIV).MethodsIn this single-center and prospective cohort study, PLwHIV were evaluated longitudinally by transient elastography at the initiation and 7 months (±1 month) after the cART.ResultsOf the 81 PLwHIV, 28.3% had hepatic steatosis, 40.7% had fibrosis (≥F1), and 24.7% had significant fibrosis (≥F2). In multivariate analysis, body mass index (BMI) (<i>p =</i> .005) and albumin (<i>p =</i> .045) were independent predictors for hepatic steatosis, while aspartate aminotransferase (AST) (<i>p =</i> .041) was an independent predictor for hepatic fibrosis. Control transient elastography was performed in 66 (81.5%) PLwHIV after treatment. Among these patients, the rate of hepatic fibrosis decreased significantly after treatment (43.9% vs 24.2%, <i>p =</i> .017). In the tenofovir alafenamide (TAF)-based regimen, weight (<i>p <</i> .001), BMI (<i>p <</i> .001), waist circumference (<i>p <</i> .001), and total cholesterol (<i>p =</i> .012) increased, while kPA value (<i>p =</i> .002) decreased. In the tenofovir disoproxil fumarate (TDF)-based regimen, controlled attenuation parameter (CAP) value (<i>p =</i> .017) and waist circumference (<i>p =</i> .006) increased. In the lamivudine (LAM)-based regimen, there was no statistically significant change (p > .05).ConclusionHepatic fibrosis regressed with antiretroviral treatments (especially with TAF-based), while the degree of hepatosteatosis progressed (especially with TDF-based). Additionally, weight gain occurred after cART in PLwHIV (especially with TAF-based). Therefore, hepatic steatosis and weight gain in PLwHIV should not be disregarded. In conclusion, PLwHIV on cART need close follow-up for the development of metabolic complications.