Changes in Hepatic Fibrosis and Steatosis Scores After Two Years of Integrase Strand Transfer Inhibitor–Based Antiretroviral Therapy

Liver steatosis and fibrosis warrant careful evaluation due to ongoing inflammation and higher risk of metabolic disorders in an increasingly aging population of People Living With HIV(PLWH). In our study, we aimed to assess liver fibrosis and steatosis using non-invasive scores both prior to antiretroviral therapy(ART) initiation and at the end of the second year of treatment. PLWH who were admitted to the Infectious Diseases Outpatient Clinic of Ankara Training and Research Hospital and initiated ART were retrospectively evaluated. Hepatic Steatosis Index (HSI), Aspartate Aminotransferase to Platelet Ratio Index(APRI), and Fibrosis-4 Index (FİB-4) scores were calculated to assess hepatosteatosis and fibrosis. Of 58 patients, 89.6% were male and the median age was 36 years. Compared to baseline, Body Mass Index (BMI), CD4 count, platelet, Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL) and total cholesterol levels were found to be statistically significantly higher at the end of the second year of INSTI-based ART. A decrease was observed in AST, APRI and FİB-4 scores. Initial AST and ALT values showed a positive influence on the decrease in APRI and FIB-4 scores, whereas albumin levels and platelet count demonstrated a negative impact on these changes. Baseline HDL and CD4 levels had a negative association with the reduction in APRI and FIB-4 scores respectively(p<0.05). The effect of Tenofovir alafenamide (TAF) containing and non-TAF containing treatment groups on second year changes was not statistically significant. Despite the BMI increase and adverse changes in lipid profiles, non -invasive scores for liver fibrosis showed significant improvement two years after ART initiation. The observed changes were not influenced by whether ART regimens contained TAF or not.