Liver Fibrosis Among People Living with HIV in Thailand

Abstract

Liver fibrosis is a critical public health concern among people living with HIV (PLHIV) due to its association with an increased risk of liver-related mortality. This study aimed to investigate the prevalence of significant liver fibrosis (F2-F4) and analyze the association between clinical factors and liver fibrosis in PLHIV in Thailand. Secondary data were obtained from the HIV-NAT 006 cohort, which included 1,032 individuals who underwent liver stiffness measurement between January 15, 2010, and July 4, 2019. Participants were categorized into two groups based on liver fibrosis severity: F0-F1 (no or mild liver fibrosis) and F2-F4 (significant liver fibrosis). Descriptive statistics and statistical tests were used for data analysis, including the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. The prevalence of significant liver fibrosis (F2-F4) was found to be 14.7%. The median age of participants was 42.9 years (IQR: 36.5–48.5), with the majority being male (61.4%). The median values for age, body mass index (BMI), waist circumference, ALT, AST, fasting blood glucose, and triglyceride levels were significantly higher in the F2-F4 group compared to the F0-F1 group (p<0.05). Additionally, the proportions of smokers, individuals with hepatitis C virus (HCV), diabetes mellitus (DM), and hypertension (HT) were significantly higher in the F2-F4 group than in the
F0-F1 group (p<0.05). Conversely, platelet count, estimated glomerular filtration rate (eGFR),
HDL-C, and CD4 cell count were significantly lower in the F2-F4 group (p<0.05). These findings highlight that metabolic abnormalities, comorbidities, HCV infection, smoking, and a lower immune system contribute to the progression of liver fibrosis in PLWH. Therefore, continuous monitoring of PLWH with these risk factors is essential to reducing the incidence of liver fibrosis and lowering the risk of liver-related mortality.