Effects of Food Insecurity on Hepatic Steatosis and Fibrosis in People With HIV

Food insecurity (FI) is a risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis in the general population, but its impact on liver disease in people with HIV (PWH) is unknown. We examined the association of FI with prevalence of NAFLD and fibrosis in a diverse cohort of PWH....

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Published in:	Clinical gastroenterology and hepatology Vol. 22; no. 7; pp. 1427 - 1435.e6
Main Authors:	Kardashian, Ani, Lloyd, Audrey, Vilar-Gomez, Eduardo, Naggie, Susanna, Sulkowski, Mark S., Woreta, Tinsay, Lake, Jordan E., Crandall, Holly, Loomba, Rohit, Wilson, Laura A., Sterling, Richard K., Heath, Sonya, Gawrieh, Samer, Chalasani, Naga P., Price, Jennifer C., Diehl, Anna Mae, Kopping, Mariko, Mangus, Rebecca, Chalasani, Naga, Cheek, Kaelea, Cummings, Oscar W., Garcia, Nicole, Releford, Montreca, Sulkowski, Mark, Brinkley, Sherilyn, Coleman, Daniel, Gilman, Lee, Mekhael, Sara, Moon, Juhi, Stelmash, Lauren, Williams, Quintara, Heath, Sonya L., Goepfert, Paul A., Gray, Meagan, Hogue, Olivia, Logan, Heather, Spraggins, Kristen, Tingle, William, Vereen, Latasha, Ajmera, Veeral, Cachay, Edward, Cervantes, Vanessa, Hernandez, Christie, Madamba, Egbert, Richards, Lisa, Tesfai, Kaleb, Tincopa, Monica, Price, Jennifer, Camberos, Rosaura, Laguardia, Yesenia, Luetkemeyer, Annie, McKinney, Jeffrey, Pearlman, Brittlyn, Stern, Sophie, Hernandez, Marisel Negret, Somasunderam, Anoma, Sterling, Richard, Devore, Megan, Nixon, Daniel
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2024
Subjects:	Adult AIDS Cross-Sectional Studies Elasticity Imaging Techniques - statistics & numerical data Fatty Liver Female Food Insecurity Food Security HIV HIV Infections - complications HIV Infections - epidemiology Humans Liver Cirrhosis - epidemiology Liver Disease Liver Health Outcomes Male MASLD Middle Aged Non-alcoholic Fatty Liver Disease - complications Non-alcoholic Fatty Liver Disease - epidemiology Prevalence Risk Factors Social Determinants of Health United States - epidemiology United States AUDIT NAFLD ART Liver Health Outcomes ALT SDOH Social Determinants of Health HBV NRTI BMI PWH AST OR CI LSM NNRTI AIDS INSTI Food Security MASLD NASH Fatty Liver CAP HIV VCTE PI HCV Liver Disease USDA HFSS
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Summary:	Food insecurity (FI) is a risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis in the general population, but its impact on liver disease in people with HIV (PWH) is unknown. We examined the association of FI with prevalence of NAFLD and fibrosis in a diverse cohort of PWH. PWH aged ≥ 18 years on antiretroviral therapy, HIV RNA <200 copies/mL, and without other known liver diseases were screened for NAFLD (controlled attenuated parameter ≥263 decibels/meter) and advanced fibrosis (liver stiffness measurement ≥11 kilopascals) by vibration controlled transient elastography at 8 U.S. centers. Participants were categorized as food insecure using the Six-Item Short Form Household Food Security Survey. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NAFLD and advanced fibrosis by FI status. Among 654 PWH, NAFLD was present in 348 (53%) and advanced fibrosis in 41 (6%). FI was present in 203 of participants (31%), including 97/348 with NAFLD (28%) and 18/41 with advanced fibrosis (44%). In multivariable analysis, FI was associated with lower odds of NAFLD (OR, 0.57; 95% CI, 0.37–0.88) and a greater, but nonsignificant, odds of advanced fibrosis (OR, 1.38; 95% CI, 0.65–2.90). We identified a significant interaction between FI and diabetes (P = .02) on fibrosis risk, with greater odds of fibrosis among food insecure PWH and diabetes (OR, 3.83; 95% CI, 1.15–12.73) but not among food insecure nondiabetics (OR, 1.12; 95% CI, 0.47–2.98). FI is highly prevalent among PWH and associated with lower odds of NAFLD, and among PWH with diabetes, there is greater odds of advanced fibrosis. FI may contribute to hepatic fibrosis through mechanisms other than steatosis in PWH.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1542-3565 1542-7714 1542-7714
DOI:	10.1016/j.cgh.2024.03.017