A0488 - Nonalcoholic Fatty Liver Disease and Risk of Cardiovascular Diseases Among Persons With HIV: A Large Multicenter Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

AK

Arukumar Krishnan, MBBS

West Virginia University School of Medicine
Morgantown, WV

Arukumar Krishnan, MBBS, Shailendra Singh, MD, Shyam Thakkar, MD
West Virginia University School of Medicine, Morgantown, WV

Introduction: The prevalence of NAFLD may be as high as 40% among persons living with the human immunodeficiency virus (PLWH). Notably, Cardiovascular disease (CVDs) is an increasing concern among PLWH. However, the association of NAFLD with the risk of CVDs is unknown, and particularly, the relationship between NAFLD and CVD among PLWH has not been well elucidated. This study aimed to explore CVD events among PLWH with NAFLD compared to PLWH without NAFLD.

Methods: This population-based, multicenter, retrospective cohort study was conducted using the TriNetX platform. All adult patients( >18 years) with HIV were identified, and among these, patients diagnosed with NAFLD were identified after excluding other chronic liver disease etiologies and included as the main group, and patients without NAFLD were included as controls (Non-NAFLD). We performed a 1:1 propensity score matching (PSM) for demographics, BMI, and comorbidities. The main outcome was major CVD events. Hazard ratio (HR) was calculated to compare the association of NAFLD with CVD outcomes.

Results: A total of 151,868 PLWH were identified. Among these, 4,969 patients had NAFLD, and 146,899 patients without NAFLD were included in the control group. After PSM, PLWH with NAFLD and without NAFLD (4,463 patients) were well matched. The majority of the patients were men (60%) and White(70.1%) in both groups. Patients with NAFLD were more likely to have more comorbidities such as diabetes, hypertension, chronic respiratory disease, hypothyroidism, CKD, sleep apnea, and hyperlipidemia than the controls. In adjusted analysis (Table 1), the risk of ischemic heart disease ( HR 2.14, 1.58-2.90), acute myocardial infarction (HR 1.80, 95% CI 1.01-3.20), heart failure (HR 3.53, 95% CI 2.13-5.87), atherosclerosis (HR 1.96, 95% CI 1.12-3.45), composite myocardial infarction (HR 1.80, 95% CI 1.01-3.20), cerebrovascular disease (HR 1.85,95% CI 1.11-3.10), stroke (HR 1.87,95% CI 1.31-2.70), arterial fibrillation (HR 2.25,95% CI 1.39-3.63), and coronary artery disease-related procedures (HR 1.89,95% CI 1.69-2.13) was significantly higher for patients with NAFLD than for patients without NAFLD

Discussion: In this large, propensity score-matched multicenter study, CVD was independently associated with prevalent NAFLD after controlling for traditional CVD risk factors in PLWH compared to those without NAFLD. NAFLD is common in PLWH and is associated with increased CV risk as in the general population

Cardiovascular Outcomes	With NAFLD (N=4463), n(%)	Without NAFLD (N=4463), n(%)	Hazard ratio (95% CI)
IHD	135(3.02%)	60(1.3%)	2.14(1.58-2.90)
HF	70(1.56%)	19(0.42%)	3.53(2.13-5.87)
Atherosclerosis	38(0.85%)	18(0.40%)	1.96(1.12-3.45)
AMI	34(0.76%)	18(0.40%)	1.80(1.01-3.20)
Composite MI*	43(0.96%)	22(0.49%)	1.85(1.11-3.10)
Cerebrovascular disease	134(3.0%)	59(1.32%)	2.19(1.61-2.97)
Stroke	88(1.97%)	45(1.0%)	1.87(1.31-2.70)
AF	56(1.25%)	24(0.53%)	2.25(1.39-3.63)
Composite Coronary artery procedures and surgeries	811(18.1%)	451(10.15)	1.89(1.69-2.13)
Abbreviations: IHD, ischemic heart disease; HF, heart failure; AMI, acute myocardial infarction; MI, myocardial infarction; AF, atrial fibrillation *Composite MI was defined based on the Non–ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction, myocardial infarction type 1, type 2, and type 3

Table: Table 1: Incidence of cardiovascular diseases in patients with and without NAFLD among PLWH after propensity matching

Disclosures:

Arukumar Krishnan indicated no relevant financial relationships.

Shailendra Singh indicated no relevant financial relationships.

Shyam Thakkar indicated no relevant financial relationships.

Arukumar Krishnan, MBBS, Shailendra Singh, MD, Shyam Thakkar, MD. A0488 - Nonalcoholic Fatty Liver Disease and Risk of Cardiovascular Diseases Among Persons With HIV: A Large Multicenter Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.