The impact of integrase inhibitors on steatosis and fibrosis biomarkers in persons with HIV naïve to antiretroviral therapy

BMC Infectious Diseases

Research

Rita Lino¹  Rosário Serrão¹  Carmela Pineiro¹  André Rodrigues Guimarães¹  Sara Rodrigues Fernandes²  Paula Freitas³  Ana Rita Leite⁴ 

[1] Departamento de Doenças Infeciosas do Centro Hospitalar Universitário São João, Porto, Portugal;Faculdade de Medicina, Universidade do Porto, Porto, Portugal;Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário São João, Faculdade de Medicina, Investigação e Inovação em Saúde (i3s), Universidade do Porto, Porto, Portugal;Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário São João, Faculdade de Medicina, Universidade do Porto, Porto, Portugal;

关键词: HIV;    Integrase strand transfer inhibitors;    Non-alcoholic fatty liver disease;    Steatosis;    Liver fibrosis;   

DOI  :  10.1186/s12879-023-08530-3

 received in 2023-05-29, accepted in 2023-08-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNon-alcoholic Fatty Liver Disease (NAFLD) has a high prevalence among persons with HIV infection. Since Integrase Strand Transfer Inhibitors (INSTIs) are used worldwide and have been associated with weight gain, we must determine their effect in the development of NAFLD and Non-alcoholic Steatohepatitis (NASH) in these patients. The aim of this study was to explore the impact of INSTIs on variation of liver steatosis and fibrosis in the ART-naïve person with HIV, using Hepatic Steatosis Index (HSI), Fibrosis-4 Index (FIB-4), BARD score and NAFLD Fibrosis Score (NFS).MethodsWe performed a monocentric, retrospective cohort study in ART-naïve persons with HIV that initiated INSTI based regimens between December 2019 and January 2022. Data was collected at baseline, 6 and 12 months after initiation. Demographic, clinical and laboratory characteristics, hepatic steatosis, and fibrosis scores were compared between baseline and last visit at 12 months. Linear regression models were performed to analyse the associations between analytical data at baseline and hepatic scores variation during the 12 months of treatment. Models were performed unadjusted and adjusted for age and sex.Results99 patients were included in our study. 82% were male and median age was 36 years. We observed a significant increase in body mass index (BMI), HDL, platelet count, albumin, and creatinine and a significant decrease in AST levels. HSI showed no statistically significant differences during follow-up (p = 0.114). We observed a significant decrease in FIB-4 (p = 0.007) and NFS (p = 0.002). BARD score showed a significant increase (p = 0.006). The linear regression model demonstrated a significant negative association between baseline HIV RNA and FIB-4 change (β= -0.08, 95% CI [-0.16 to -0.00], p = 0.045), suggesting that higher HIV RNA loads at baseline were associated with a greater decrease in FIB-4.ConclusionINSTIs seem to have no impact on hepatic steatosis, even though they were associated with a significant increase in BMI. This might be explained by the direct effect of a dolutegravir-containing regimen and/or by the “return-to-health effect” observed with ART initiation. Furthermore, INSTIs were associated with a reduction in risk of liver fibrosis in ART-naïve persons with HIV, possibly due to their effect on viral suppression.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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