Viral Infections

Paula Debroy on the Link Between Hepatic Steatosis and Frailty in People With HIV


In this podcast, Paula Debroy, from the University of Texas at Houston, talks about the research she recently presented at CROI 2020. Her team's latest study investigated the relationships between frailty, sarcopenia, and nonalcoholic fatty liver disease in people with HIV.



Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator Amanda Balbi with Consultant360 Specialty Network.

The Conference on Retroviruses and Opportunistic Infections 2020 was a virtual meeting of the minds in infectious disease and public health.

Frailty and sarcopenia are associated with abdominal obesity and obesity-related comorbidities, but their relationship with non-alcoholic fatty liver disease in people with HIV has not been described. A research team who presented their study at CROI 2020 assessed the associations between NAFLD, sarcopenia, and components of a frailty-related phenotype among participants in the Multicenter AIDS Cohort Study.

I’m joined today by the presenting author of the research, Paula Debroy, who is a clinical HIV fellow at the University of Texas at Houston. She recently completed her infectious disease fellowship and will complete her HIV fellowship this summer.

Thank you for joining me today Paula. Let’s dive into your study.

To start, can you give us an overview of your research you presented at CROI?

Paula Debroy: Alright. So just a little bit of background—we know that frailty and sarcopenia have been associated with obesity-related comorbidities, insulin resistance, and nonalcoholic fatty liver. And we are beginning to understand that the muscle communicates with the liver and adipose tissue and rep plays a big role in the pathogenesis of insulin resistance and fatty liver as well.

And this association has been established in people without HIV, but we do not know if there is a relationship in HIV, and it's not only the quantity, of the muscle, but also the quality—which the criteria that we use for frailty to look at weakness, exhaustion, little physical activity level, and slowness.

In this cross-sectional analysis, we looked at the participants of the MACS cardiovascular disease 2 sub-study. And we were looking to see if there any of those associations between fatty liver disease and the frailty-related phenotypes.

Amanda Balbi: Great. Let’s take a step further. How do the relationships between hepatic steatosis and frailty differ by HIV serostatus?

Paula Debroy: So in our study, we found that fatty liver was only associated with a frailty-related phenotype in men without HIV, and this is with an all-probability ratio of 2.6 and no significant P value. However, this relationship was not seen in men with HIV.

Not all of our patients had associations for sarcopenia, which is another component that we saw, not only frailty syndrome looking at muscle function, but also sarcopenia itself. And also there was no relationship in our study. However, it might have been underpowered because not all of the patients had sarcopenia evaluation by DEXA scan. So it was only a subset of the patients that had it.

Amanda Balbi: Absolutely. So what would you say is the key take-home message from this study?

Paula Debroy: Our main key message is that the pathogenesis of fatty liver might differ in people living with HIV. So, you know, the standard treatments that we have for fatty liver are mainly lifestyle modifications, and as we begin to see this relationship with frailty and sarcopenia, maybe strengthening exercises and muscle strength activity to improve fatty liver has some impact, but the pathogenesis in people living with HIV might differ and might have a different component that we will not target or achieve any impact on the fatty liver in people living with HIV with this traditional lifestyle modification.

And definitely, we need to see if this relationship between muscle and fatty liver are preserved in HIV, maybe in other populations, you know. Our study is limited because it's only men, but it seems to be that, in this cohort at least, there is no a relationship.

We're starting to understand the fatty liver disease in HIV and especially trying to target treatment. So, you know, studies like these are important to help us elucidate a little bit more on the pathogenesis and try ultimately to develop a treatment that's more targeted for people living with HIV.

Amanda Balbi: Great. Are you working on other research at the moment as a follow-up to this study?

Paula Debroy: So we are looking at longitudinal analyses to see if people that develop frailty will then develop fatty liver or the participants that had sarcopenia will develop fatty liver at some point. And if there's any relationship with the other markers, the individual markers of frailty, such as weakness, you know, decrease grip strength, and chair stand as well.

Amanda Balbi: Absolutely. Thank you so much for speaking with me today and shedding light on your research.

Paula Debroy: Well, thank you for your interest. I'm happy to participate and communicate our findings.


Additional Resource:

Debroy P, Barrett B, Erlandson KM, et al. Relationships between hepatic steatosis and frailty differ by HIV serostatus. Paper presented at: Conference on Retroviruses and Opportunistic Infections 2020; March 8-11, 2020; Boston, MA.


Paula Debroy is a clinical HIV fellow at the University of Texas at Houston. She recently completed her infectious disease fellowship and will complete her HIV fellowship this summer.