Eight‐year changes in hepatic steatosis and associated metabolic factors in a Japanese cohort of people with HIV

OBJECTIVES: Hepatic steatosis is an increasingly important liver-related comorbidity among people with HIV. We evaluated longitudinal changes in hepatic steatosis over 8 years and the associated clinical factors in a single-centre Japanese cohort of people with HIV. METHODS: This single-centre retrospective cohort study included 94 people with HIV who underwent paired FibroScan assessments a median of 8.18 years apart. Hepatic steatosis was defined as a controlled attenuation parameter (CAP) ≥238 dB/m, with incident steatosis defined as CAP < 238 dB/m at baseline and CAP ≥238 dB/m at follow-up. Factors associated with incident steatosis and follow-up CAP were assessed using Firth's penalized logistic regression and an analysis of covariance (ANCOVA)-type multivariable linear model, respectively. RESULTS: Median CAP increased from 232 to 282 dB/m (p < 0.001), while the prevalence of hepatic steatosis increased from 45/94 (48%) to 63/94 (67%) (p = 0.001). Of 49 participants without baseline steatosis, 24 (49%) developed incident steatosis. After adjustment for baseline CAP, greater percentage weight gain, higher baseline body mass index and triglycerides ≥200 mg/dL at follow-up were each associated with higher follow-up CAP, whereas tenofovir alafenamide (TAF) exposure during follow-up was not. Median liver stiffness measurement (LSM) did not change significantly. CONCLUSIONS: CAP values and the prevalence of hepatic steatosis increased over 8 years in this single-centre Japanese cohort of people with HIV. Greater weight gain and metabolic abnormalities were associated with higher CAP at follow-up. These observational findings suggest that monitoring body weight, metabolic parameters, hepatic steatosis and liver stiffness may be useful in long-term HIV care.