Page 295 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 6 Original Research

NAFLD in mono-infected HIV people was similar to that of with ultrasensitive reverse transcriptase-PCR Amplicor HIV
6,7
the general population, namely 30%. Currently, cART is Monitor 1.5 [Roche Molecular Systems, Basel, Switzerland]).
initiated as soon as HIV infection is diagnosed. Treatment is
lifelong. In the current era, the prevalence of NAFLD in the The data on co-morbidities and associated risk factors were
HIV-infected on cART is 10% higher than that of the also collected: smoking (in years), alcohol consumption,
uninfected. Several antiretrovirals (ARVs) cause lipid or fat diagnosis and therapy of diabetes, diagnosis and therapy of
8
toxicity. This results in lipodystrophy, for example weight arterial hypertension, cardiovascular and metabolic disorders.
gain, hyperlipidaemia, insulin resistance, loss of fat Family history data were also collected: data on familial
(lipoatrophy) and the redistribution of fat from the periphery presence of diabetes, cardiovascular disease in male (age
to the centre of the body. The latter promotes the accumulation under 55 years) and female (under 65 years of age) relatives.
of fat in the liver. Viral persistence – even when levels are
undetectable – and the accompanying systemic inflammation This study received funding from the Provincial Secretariat
are responsible for the metabolic derangement of the fat cell. for Higher Education and Scientific Research, Autonomous
8
Accelerated ageing, a further consequence of viral persistence, Province of Vojvodina, Republic of Serbia. Project name:
manifests as the premature onset of comorbid disease. Risk ‘Cardiometabolic syndrome and its impact on the cognitive
factors such as diet, smoking, lack of exercise and genetic functions in people living with HIV’. Grant number: 114-451-
predisposition ensure that many of the HIV-infected on cART 497/2016-01.
develop end-organ disease and malignancy 10–15 years
before their uninfected peers. 8,9,10,11,12 Anthropometric data
The VFT is measured using ultrasonography (US). The
The aim of this study was to examine visceral fat thickness technique requires less skill than liver US and has been
(VFT) and its relationship to other anthropometric shown to be a reliable and non-invasive measure of the
measurements associated with NAFLD in mono-infected visceral fat compartment. Ultrasonography was performed
13
HIV-positive subjects on long-standing cART so as to identify in the supine position using an abdominal 3.5 MHz convex
those at risk in order to halt progression to NASH, cirrhosis probe at high resolution (Shimadzu SDU-1100). The
and hepatocellular carcinoma. measurements were performed during end expiration to
avoid the influence of respiratory movement. The VFT was
Materials and methods measured in the transverse plane, in the midline, where
Participants the xiphoid line intercepts the waist circumference (WC).
The ‘thickness’ is the distance between the anterior margin
A total of 88 HIV-positive male patients, average age 39.94 ± of the vertebral body and the posterior fascia of the
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9.91 years, were included in this institutional ethics board muscles of the anterior abdominal wall. Three subsequent
approved study (clinical centre of Vojvodina, No. 00-81/229). measurements were performed and the mean value was
The study began in September 2016 and ended in April 2018. calculated. The cut-off value of the VFT for the diagnosis of
Inclusion criteria: age = 22–50 years, male gender, confirmed hepatic steatosis is determined from the receiver operating
HIV-positive status on polymerase chain reaction (PCR), characteristic (ROC) curve and the Youden index. Liver US
clinically stable, namely good adherence to cART, an was performed in the morning, after fasting for at least 10 h.
unchanged current drug regimen for ≥ 1 year, at least two The presence of hepatic steatosis was assessed by the same
radiologist. US reporting was qualitative and ‘staging’ of the
consecutive suppressed viral loads. Women were excluded hepatic steatosis was not performed. The hepatic parenchymal
as we had insufficient numbers in our clinic to provide echo pattern was, however, scored as:
gender equipoise. Exclusion criteria: major psychiatric
disorder, active opportunistic infection, history of drug 1. ‘Without steatosis’, when echoes were homogeneously
dependence according to the Statistical Manual of Mental distributed and liver echogenicity was not increased in
Disorders, except for nicotine and alcohol consumption relation to the parenchyma of the right kidney.
< 20 g/day, co-infection with hepatitis B or C viruses. The 2. ‘With steatosis’, if echogenicity was increased when
compared to the parenchyma of the right kidney and in
following clinical and laboratory data were checked: duration the more severe forms of fatty infiltration, when
of HIV infection, duration of cART, viral load, nadir and accompanied by posterior beam attenuation and impaired
current CD4+ count, fasting blood glucose level, serum visualisation of the intrahepatic vessels and diaphragm. 15
triglycerides, serum low- and high-density lipoprotein
cholesterol. Nadir CD4+ count represents the lowest CD4+ The WC was simply measured as the circumference just
T-cell count observed in HIV-positive subject’s history, above the umbilicus. The hip circumference (HC) was
usually seen at the initiation of cART. Current CD4+ count measured at the widest distance between the hips. All
and viral load data were available from electronic charts, and measurements were performed by trained staff using a non-
were obtained in the same week as the measurements. Blood stretchable tape. Body mass index (BMI), waist-to-hip ratio
glucose, triglyceride and cholesterol levels were determined (W/H) and waist-to-height ratio (WHtR) were calculated for
from fresh venous blood using standard laboratory methods, each subject. Body mass index is a measure of body fat based
also in the same week as the measurements. Viral load was on the ratio of weight and height (in kg/m ). Waist-to-hip
2
determined at each 6-month follow-up visit (determined ratio is calculated as WC (in cm) divided by the HC (in cm).

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