Evolution of Fatty Liver Disease and Relationship With Lipoproteins and Clinical Outcomes in Hepatitis B/Human Immunodeficiency Virus Coinfection

Mandana Khalili, Wendy C. King, David E. Kleiner, Raymond T. Chung, Atul K. Bhan, Marc G. Ghany, Mark S. Sulkowski, Mauricio Lisker-Melman, Mamta K. Jain, Harry L.A. Janssen, Amanda S. Hinerman, Arun J. Sanyal, Richard K. Sterling

Research output: Contribution to journalArticlepeer-review


Background: Fatty liver disease (FLD) and hepatitis B virus (HBV) infection occur commonly in human immunodeficiency virus (HIV). FLD resolution is associated with improvement in lipoproteins in HIV-uninfected patients. We evaluated changes in FLD in an HBV/HIV-coinfected cohort. Methods: One hundred eight HBV/HIV-coinfected adults with baseline liver biopsies were followed every 24 weeks (median, 166 weeks) and 60 had follow-up biopsies. Baseline FLD categories (none, ≥5% steatosis, steatohepatitis), their change, and relationships with clinical and lipid/lipoprotein parameters were explored using multivariable modeling. Results: Median age was 50 years, and 93% were male. At baseline 30% had FLD. With control for lipid-lowering medications and body mass index, low-density lipoprotein (LDL) cholesterol (LDL-C), LDL particle concentration (LDL-P), and apolipoprotein B (apoB) decreased and adiponectin increased over time (all P <. 05); On follow-up (vs baseline), there was no significant difference in FLD category (P =. 85); 60% remained without FLD, 17% had unchanged, 12% worsening, and 12% improved FLD. Baseline low-density lipoproteins (LDL-C, LDL-P, small LDL-P) and apoB appeared highest in those with unchanged FLD status (all P <. 05). No associations between changes in FLD across follow-up (worsening/improvement vs unchanged) and lipid/lipoproteins changes were identified. Conclusions: In this cohort, there was no significant change in FLD prevalence over a relatively short timeframe. Baseline atherogenic lipids appeared highest in those with persistent steatosis or steatohepatitis, suggesting potentially increased cardiovascular risk in this group, but an independent relationship between individual-level change in FLD status and lipid/lipoprotein levels across follow-up was not observed.

Original languageEnglish
Pages (from-to)1914-1924
Number of pages11
JournalClinical Infectious Diseases
Issue number11
StatePublished - Jun 1 2022


  • cardiovascular risk
  • insulin resistance
  • lipids
  • nonalcoholic fatty liver disease
  • nonalcoholic steatohepatitis


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