CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

742

Race/Ethnicity and Risk of NAFLD and Clinically Significant Fibrosis in Persons Living With HIV Tinsay A. Woreta 1 , Mark Sulkowski 1 , Yuchen Xin 2 , Laura Wilson 3 , Eduardo Vilar-Gomez 4 , Samer Gawrieh 4 , Kathleen Corey 5 , Jennifer Price 6 , Susanna Naggie 7 , Sonya Heath 8 , Richard Sterling 9 , James Tonascia 3 , Rohit Loomba 10 , Naga Chalasani 4 , Jordan E Lake 11 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins University, Baltimore, MD, USA, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Indiana University, Indianapolis, IN, USA, 5 Massachusetts General Hospital, Boston, MA, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 Duke University School of Medicine, Durham, NC, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA, 9 Virginia Commonwealth University, Richmond, VA, USA, 10 University of California San Diego, San Diego, CA, USA, 11 University of Texas at Houston, Houston, TX, USA Background: Racial and ethnic differences in non-alcoholic fatty liver disease (NAFLD) prevalence are well described in the general population, with Hispanics having the highest and African Americans having the lowest NAFLD prevalence. Whether similar disparities exist in persons with HIV (PWH) with NAFLD is largely unknown. We investigated racial and ethnic differences in the prevalence of NAFLD and clinically significant fibrosis (CSF) among PWH. Methods: This cross-sectional analysis included participants ≥ 18years of age prospectively enrolled in two U.S. multicenter studies from 2018-2023 who had 1) a documented history of HIV on antiretroviral therapy with HIV-1 RNA <200 copies/mL 2) vibration controlled transient elastography (Fibroscan®) performed, and 3) a self-reported racial/ethnic group listed as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic. NAFLD was defined by a controlled attenuation parameter (CAP) score ≥263 dB/m in the absence of excessive alcohol consumption and other causes of liver disease. CSF was defined as a liver stiffness measurement (LSM) ≥8 kPa. Multivariable logistic regression analysis was performed to examine associations between race/ ethnicity and the presence of NAFLD and CSF. Results: The study population included 1067 PWH with a mean age of 52 years and 73% with male sex at birth. 515 (48%) of participants were NHB, and 239 (22%) were Hispanic. NAFLD prevalence was highest for Hispanics (65%) and lowest for NHB (44%) compared to 57% for NHW (overall p< 0.001). The prevalence of CSF was highest for NHW (22%) compared to 15% for Hispanics and 11% for NHB (overall p<0.001). After adjusting for clinically relevant variables (Table), NHB had a lower risk of both NAFLD (adjusted OR: 0.43, 95% CI: 0.28-0.66) and CSF (adjusted OR 0.42, 95% CI: 0.26-0.68) compared to NHW. The adjusted analysis showed no differences in the risk of NAFLD or CSF between Hispanics and NHW (Table). Conclusion: In this large, multi-ethnic cohort study of persons with well controlled HIV, non-Hispanic Black participants had approximately 60% lower odds of having NAFLD and CSF compared to non-Hispanic Whites, after adjusting for clinically relevant risk factors. Hispanics did not have a higher risk after adjustment. Further studies are needed to determine the factors associated with racial and ethnic differences in NAFLD in PWH, including genetic variation.

significant fibrosis among individuals on antiretroviral therapy (ART) in the Swiss HIV Cohort Study. Methods: We enrolled cohort participants at Bern University Hospital into a prospective observational study between November 2019 and April 2022. Individuals with viral hepatitis co-infection and pregnant women were excluded. We performed yearly liver assessments using vibration controlled transient elastography (VCTE) and included all patients with at least two measurements. Liver steatosis was defined as controlled attenuation parameter (CAP) ≥248dB/m. We calculated the Fibroscan-AST (FAST) score based on liver stiffness measurement (LSM), CAP and AST; A FAST score >0.67 indicated steatohepatitis with significant fibrosis. We investigated risk factors for de novo steatosis using multivariable logistic regression. Results: Of 457 individuals enrolled, 368 (80.5%) with ≥2 valid VCTE measurements were included. Median follow-up time was 30 months (IQR 23-37), 105 participants (28.5%) were female and 261 (70.9%) Caucasian. At time of first VCTE, their median age was 52 years (interquartile range [IQR] 43-59), median CD4+ count was 728 cells/μl (IQR 547-939), and 193 (53.3%) had a BMI≥25kg/m². Median ART duration was 11 (IQR 6-19) years and 344 (93.5%) had a HIV viral load <50 copies/mL. At first VCTE, 190 participants (51.6%) had liver steatosis, of whom 6 (3.2%) showed steatohepatitis with significant fibrosis. Of 178 participants who did not have liver steatosis at their first assessment, 51 (28.7%) developed liver steatosis during follow-up. In multivariable analysis, BMI≥25kg/m² (adjusted odds ratio [aOR], 3.40; 95% confidence interval [CI], 1.66-6.96) and dyslipidemia (aOR 2.59; 95% CI 1.14-5.88) were significantly associated with the development of steatosis. Sex, age and specific ART components were not associated with de novo steatosis. Among 190 participants with steatosis at first VCTE, 6 (3.1%) developed steatohepatitis with significant fibrosis during follow-up. Conclusion: During three years of follow-up, one in four PWH developed de novo steatosis, with obesity and dyslipidemia being the most important predictors. The progression of liver steatosis to steatohepatitis with significant fibrosis was rare. A Gut Microbiome Signature for HIV and Non-Alcoholic Fatty Liver Disease Javier Martínez-Sanz 1 , Alba Talavera-Rodríguez 1 , Jorge Díaz-Álvarez 1 , Marta Rosas Cancio-Suárez 1 , Juan Miguel Rodríguez-Gómez 2 , Claudio Sanz 2 , María Luisa Montes 3 , Rosa Martín-Mateos 1 , Diego Burgos-Santamaría 1 , Santiago Moreno 1 , Sergio Serrano-Villar 1 , Matilde Sánchez-Conde 1 1 Hospital Ramón y Cajal, Madrid, Spain, 2 Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain, 3 La Paz University Hospital, Madrid, Spain Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as an increasingly recognized problem among people living with HIV (PLWH). The gut-liver axis is considered to be strongly implicated in the pathogenesis of NAFLD. We aimed to characterize the gut microbiota composition in PLWH and NAFLD and compare it with that of two control groups: PLWH without NAFLD and individuals with NAFLD without HIV infection. Methods: We collected clinical data and stool samples from participants. Bacterial 16S rRNA genes were amplified, sequenced, and clustered into operational taxonomic units. Alpha diversity was studied by the Shannon and Simpson indexes. To study how different the gut microbiota composition is between the different groups, beta diversity estimation was evaluated by principal coordinate analysis (PCoA) using Bray-Curtis dissimilarity. To further analyze differences in microbiome composition, we performed a linear discriminant analysis (LDA) effect size (LEfSe). We selected the genus with a LDA score >4. Results: We included 30 HIV+NAFLD+, 30 HIV+NAFLD- and 20 HIV-NAFLD+ participants. Major butyrate producers, including Faecalibacterium, Ruminococcus, and Lachnospira dominated the microbiota in all three groups. Shannon's and Simpson's diversity metrics were higher among NAFLD+ individuals (Kruskal-Wallis p = 0.047). Beta diversity analysis showed distinct clustering in NAFLD-, with NAFLD+ participants overlapping regardless of HIV status (ADONIS significance <0.001) (Figure 1A). NAFLD was associated with increased homogeneity across individuals, in contrast to that observed in the HIV+NAFDL- group, in which the dispersion was higher (Permanova test, p value <0.001; ANOSIM, p value <0.001). NAFLD but not HIV determined a different microbiota structure (HIV+NAFLD- vs. HIV+NAFLD+, q-value = 0.002; HIV NAFLD+ vs. HIV+NAFLD+, q-value = 0.930; and HIV-NAFLD+ vs. HIV+NAFLD-, q-value < 0.001). The most abundant genera in NAFLD- were Prevotella,

Poster Abstracts

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743

De Novo Liver Steatosis Among People With HIV On Contemporary Antiretroviral Therapy Carlotta Riebensahm 1 , Nicholas Giamboni 1 , Julia Brocker 1 , Bernard Surial 1 , Huldrych F. Günthard 2 , Philip E. Tarr 3 , Hansjakob Furrer 1 , Annalisa Berzigotti 1 , Andri Rauch 1 , Gilles Wandeler 1 1 University Hospital of Bern, Bern, Switzerland, 2 University Hospital Zurich, Zurich, Switzerland, 3 Kantonsspital Baselland, Bruderholz, Switzerland Background: Liver steatosis affects close to 50% of people with HIV (PWH), but longitudinal data are lacking. We investigated the incidence and determinants of de novo steatosis and described the progression to steatohepatitis with

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