The impact of integrase inhibitors on the development of hepatic steatosis and fibrosis in HIV-monoinfected patients

• Autor(a) principal: Sara Rodrigues Fernandes
• Data de Publicação: 2023
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/150370
• topic: Ciências médicas e da saúde; Medical and Health sciences

Background: Non-alcoholic Fatty Liver Disease (NAFLD) has a high prevalence among patients 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 in the development of liver steatosis and fibrosis in the patient with HIV infection, using Hepatic Steatosis Index (HSI), Fibrosis-4 Index (FIB-4), BARD score and NAFLD Fibrosis Score (NFS). Methods: We performed a monocentric, retrospective cohort study in HIV-monoinfected cART-naïve patients 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. Results: 99 patients were included in our study. Eighty-two percent 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. Conclusion: INSTIs 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 cART initiation. Furthermore, INSTIs were associated with a reduction in risk of liver fibrosis in HIV-monoinfected patients, possibly due to their effect on viral suppression.