Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia
Introduction The growing importance of non-communicable diseases (NCDs) and high HIV prevalence in urban African settings may increase the burden of metabolic dysfunction-associated fatty liver disease (MAFLD). We assessed liver steatosis among HIV-positive and negative adults in urban Zambia.Method...
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| Format: | Article |
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BMJ Publishing Group
2022-08-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e000945.full |
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| author | Matthias Egger Gilles Wandeler Samuel Bosomprah Annalisa Berzigotti Edford Sinkala Roma Chilengi Lloyd Mulenga Andri Rauch Belinda Varaidzo Chihota Carlotta Riebensahm Guy Muula Michael J Vinikoor Carolyn Bolton-Moore |
| author_facet | Matthias Egger Gilles Wandeler Samuel Bosomprah Annalisa Berzigotti Edford Sinkala Roma Chilengi Lloyd Mulenga Andri Rauch Belinda Varaidzo Chihota Carlotta Riebensahm Guy Muula Michael J Vinikoor Carolyn Bolton-Moore |
| author_sort | Matthias Egger |
| collection | DOAJ |
| description | Introduction The growing importance of non-communicable diseases (NCDs) and high HIV prevalence in urban African settings may increase the burden of metabolic dysfunction-associated fatty liver disease (MAFLD). We assessed liver steatosis among HIV-positive and negative adults in urban Zambia.Methods Adults 30 years and older who were newly diagnosed with HIV, or tested HIV-negative at two primary care clinics in Lusaka, Zambia, were assessed for liver steatosis. Cardiometabolic data were collected through comprehensive clinical and laboratory assessments. Transient elastography was performed to measure controlled-attenuation parameter (≥248 dB/m). We used multivariable logistic regression models to determine the factors associated with the presence of steatosis.Results We enrolled 381 patients, including 154 (40%) antiretroviral therapy-naïve people living with HIV (PLWH) with a median CD4+ count of 247 cells/mm3 and a mean body mass index (BMI) of 23.8 kg/m2. Liver steatosis was observed in 10% of participants overall and was more common among HIV-negative adults than in PLWH (15% vs 3%). The proportion of patients with steatosis was 25% among obese (BMI ≥30 kg/m2) participants, 12% among those overweight (BMI 25–29.9 kg/m2), and 7% among those with a BMI <25 kg/m2. Among patients with a fasting glucose ≥7 mmol/L or confirmed diabetes, 57% had liver steatosis. In multivariable analyses, HIV status (adjusted odds ratio (aOR) 0.18, 95% CI 0.06 to 0.53), confirmed diabetes or elevated fasting glucose (aOR 3.92, 95% CI 1.57 to 9.78) and elevated blood pressure (aOR 2.95, 95% CI 1.34 to 6.48) were associated with steatosis. The association between BMI>25 kg/m2 and liver steatosis was attenuated after adjustment for potential confounders (aOR 1.96, 95% CI 0.88–4.40). Overall, 21 (9%) participants without HIV and 4 (3%) with HIV met the criteria for MAFLD. Among individuals with liver steatosis, 65% (95% CI 49% to 80%) fulfilled criteria of MAFLD, whereas 15 (39%) of them had elevated transaminases and 3 (8%) F2–F4 fibrosis.Conclusions The prevalence of liver steatosis in this urban cohort of HIV-positive and negative adults in Zambia was low, despite a large proportion of patients with high BMI and central obesity. Our study is among the first to report data on MAFLD among adults in Africa, demonstrating that metabolic risk factors are key drivers of liver steatosis and supporting the adoption of the criteria for MAFLD in African populations. |
| first_indexed | 2024-03-13T00:50:37Z |
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| language | English |
| last_indexed | 2024-03-13T00:50:37Z |
| publishDate | 2022-08-01 |
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| series | BMJ Open Gastroenterology |
| spelling | doaj.art-bc8bfb5a88974909ade7303b6277bcf62023-07-07T20:00:05ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-08-019110.1136/bmjgast-2022-000945Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban ZambiaMatthias Egger0Gilles Wandeler1Samuel Bosomprah2Annalisa Berzigotti3Edford Sinkala4Roma Chilengi5Lloyd Mulenga6Andri Rauch7Belinda Varaidzo Chihota8Carlotta Riebensahm9Guy Muula10Michael J Vinikoor11Carolyn Bolton-Moore12Centre for Infectious Disease Research, University of Cape Town, Cape Town, South AfricaInstitute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandCentre for Infectious Disease Research in Zambia, Lusaka, ZambiaDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Internal Medicine, University Teaching Hospital, Lusaka, ZambiaCentre for Infectious Disease Research in Zambia, Lusaka, ZambiaMinistry of Health, Lusaka, ZambiaDepartment of Infectious Diseases, Bern University Hospital, University of Bern, Bern, SwitzerlandGraduate School of Health Sciences, University of Bern, Bern, SwitzerlandGraduate School of Health Sciences, University of Bern, Bern, SwitzerlandCentre for Infectious Disease Research in Zambia, Lusaka, ZambiaDepartment of Medicine, The University of Alabama, Birmingham, Alabama, USACenter for Infectious Disease Research in Zambia, Lusaka, ZambiaIntroduction The growing importance of non-communicable diseases (NCDs) and high HIV prevalence in urban African settings may increase the burden of metabolic dysfunction-associated fatty liver disease (MAFLD). We assessed liver steatosis among HIV-positive and negative adults in urban Zambia.Methods Adults 30 years and older who were newly diagnosed with HIV, or tested HIV-negative at two primary care clinics in Lusaka, Zambia, were assessed for liver steatosis. Cardiometabolic data were collected through comprehensive clinical and laboratory assessments. Transient elastography was performed to measure controlled-attenuation parameter (≥248 dB/m). We used multivariable logistic regression models to determine the factors associated with the presence of steatosis.Results We enrolled 381 patients, including 154 (40%) antiretroviral therapy-naïve people living with HIV (PLWH) with a median CD4+ count of 247 cells/mm3 and a mean body mass index (BMI) of 23.8 kg/m2. Liver steatosis was observed in 10% of participants overall and was more common among HIV-negative adults than in PLWH (15% vs 3%). The proportion of patients with steatosis was 25% among obese (BMI ≥30 kg/m2) participants, 12% among those overweight (BMI 25–29.9 kg/m2), and 7% among those with a BMI <25 kg/m2. Among patients with a fasting glucose ≥7 mmol/L or confirmed diabetes, 57% had liver steatosis. In multivariable analyses, HIV status (adjusted odds ratio (aOR) 0.18, 95% CI 0.06 to 0.53), confirmed diabetes or elevated fasting glucose (aOR 3.92, 95% CI 1.57 to 9.78) and elevated blood pressure (aOR 2.95, 95% CI 1.34 to 6.48) were associated with steatosis. The association between BMI>25 kg/m2 and liver steatosis was attenuated after adjustment for potential confounders (aOR 1.96, 95% CI 0.88–4.40). Overall, 21 (9%) participants without HIV and 4 (3%) with HIV met the criteria for MAFLD. Among individuals with liver steatosis, 65% (95% CI 49% to 80%) fulfilled criteria of MAFLD, whereas 15 (39%) of them had elevated transaminases and 3 (8%) F2–F4 fibrosis.Conclusions The prevalence of liver steatosis in this urban cohort of HIV-positive and negative adults in Zambia was low, despite a large proportion of patients with high BMI and central obesity. Our study is among the first to report data on MAFLD among adults in Africa, demonstrating that metabolic risk factors are key drivers of liver steatosis and supporting the adoption of the criteria for MAFLD in African populations.https://bmjopengastro.bmj.com/content/9/1/e000945.full |
| spellingShingle | Matthias Egger Gilles Wandeler Samuel Bosomprah Annalisa Berzigotti Edford Sinkala Roma Chilengi Lloyd Mulenga Andri Rauch Belinda Varaidzo Chihota Carlotta Riebensahm Guy Muula Michael J Vinikoor Carolyn Bolton-Moore Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia BMJ Open Gastroenterology |
| title | Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia |
| title_full | Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia |
| title_fullStr | Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia |
| title_full_unstemmed | Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia |
| title_short | Liver steatosis and metabolic dysfunction-associated fatty liver disease among HIV-positive and negative adults in urban Zambia |
| title_sort | liver steatosis and metabolic dysfunction associated fatty liver disease among hiv positive and negative adults in urban zambia |
| url | https://bmjopengastro.bmj.com/content/9/1/e000945.full |
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