research summary

CVD Risk Is Increased in Patients with HIV and NAFLD, Liver Fibrosis

Leigh Precopio

Individuals living with HIV who also have non-alcoholic fatty liver disease (NAFLD) or liver fibrosis may be at an increased risk of atherosclerotic cardiovascular disease (ASCVD), according to the results of a recent study.

The researchers aimed to assess the impact of NAFLD and liver fibrosis on intermediate-to-high risk of CVD among individuals with HIV. They included 941 patients across three cohorts and excluded any patients who had a hepatitis B and/or hepatitis C co-infection, a history of alcohol abuse, or had unreliable transient elastography measurements.

Transient elastography was used to measure both NAFLD and liver fibrosis, with thresholds of 288 dB/m or greater for the controlled attenuation parameter and 7.1 or greater for the liver stiffness measurement, respectively. Additionally, ACVD risk was estimated among participants aged 40 to 74 years and was categorized into low (< 5%), borderline (5-7.4%), intermediate (7.5-19.9%), and high (20% or with a previous cardiovascular event). Predictors of CVD risk were stratified by BMI (cut off at 25 and 30 kg/m2) and age (cut off at 60 years).

The results indicated that 45% (n = 423) of patients were categorized as low ASCVD risk, 13.6% (n = 128) as borderline, 27.6% (n = 260) as intermediate, and 13.8% (n = 130) as high risk.

Among the predictors of intermediate-to-high ASCVD risk were:

  • NAFLD (adjusted odds ratio [aOR] = 2.11 [95% CI, 1.40 - 3.18]; p < .001)
  • Liver fibrosis (aOR = 1.64 [95% CI, 1.03-2.59]; p = .034)
  • Duration of HIV infection (aOr = 1.04 [95% CI, 1.02 - 1.06]; p < .001)
  • Previous exposure to thymidine analogues and/or didanosine (aOR = 1.54 [95% CI, 1.09 - 2.18]; p = .014)

Additionally, a higher ASCVD risk was observed for NAFLD in patients who were normoweight (aOR = 2.97 [95% CI, 143 - 6.16]; p = .003), in patients with a BMI of less than 30 kg/m2 (aOR = 2.30 [95% CI, 1.46 - 3.61]; p < .001), and in patients aged less than 60 years (aOR = 2.19 [95% CI, 1.36 - 3.54]; p = .001).

Funding for the diagnostic center for hepatic fibrosis and steatosis at McGill University Health Center was provided by ViiV and Merck. Several authors have acted as advisory board members or speakers for Gilead, Janssen, and more. See the full study for the complete list of conflicts of interest.

“Assessment of cardiovascular disease should be targeted in people living with HIV with NAFLD and/or significant liver fibrosis, even if they are normoweight and young,” the researchers concluded.



Cervo A, Sebastiani G, Milic J, et al. Dangerous liaisons: NAFLD and liver fibrosis increase cardiovascular risk in HIV. HIV Med. 2022;23(8):911-921.