HIV infected individuals are at risk for developing NAFLD, and prior studies have shown that NAFLD is more common in HIV people than those who don’t have HIV. There is also an increased chance for lipodystrophy for people who have HIV and do a combination antiretroviral therapy (zidovudine and stavudine).
Lipodystrophy, which is antiretroviral-drug induced, is noted by lipoatrophy, which also has insulin resistance features such as disturbed glucose metabolism, and increases liver fat. People who have lipodystrophy and HIV have an increased chance for T2DM, but there have been no longitudinal studies. The study looked at the natural progression of NAFLD and T2DM in HIV-positive individuals who did and did not have lipodystrophy over the course of 15+ years.
14 HIV positive people were involved with the study, and another 28 healthy individuals were included. Baseline measurements for clinical characteristics and protein magnetic resonance spectroscopy were taken at the start, and again, when the study was over. Researchers measured for liver stiffness to measure the liver fibrosis using both magnetic resonance elastography and transient elastography.
In the study’s 16 years, the results showed T2DM progression was more common in HIV positive individuals than NAFLD progression. They also gained more bodyweight, had more insulin resistance features (insulin, fasting glucose, etc.) and were at increased risk for developing T2DM.
A look at the people without lipodystrophy found that LFAT was more at the baseline than those without it. But, it stayed stable in all the groups at the follow-up. It also found that liver stiffness with transient elastography was about the same at the follow-up, and there was liver stiffness in both groups. In three lipodystrophy patients, there was advanced fibrosis but none with the non-lipodystrophy.
The authors determined, using the current determinations of liver stiffness, that advanced fibrosis is an extremely rare complication when likened type HIV positive individuals with type 2 diabetes.
Written by Mark Riegel, MD
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