Original Research

Associations of visceral fat thickness and anthropometric measurements with non-alcoholic fatty liver disease development in male patients mono-infected with human immunodeficiency virus

Miloš Vujanović, Nina Brkić-Jovanović, Dalibor Ilić, Zorka Drvendžija, Biljana Srdić-Galić, Vesna Turkulov, Snežana Brkić, Daniela Marić
Southern African Journal of HIV Medicine | Vol 20, No 1 | a968 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.968 | © 2019 Milos Vujanovic, Nina Brkic Jovanovic, Dalibor Ilic, Zorka Drvendzija, Biljana Srdic Galic, Vesna Turkulov, Snezana Brkic, Daniela Maric | This work is licensed under CC Attribution 4.0
Submitted: 19 March 2019 | Published: 07 August 2019

About the author(s)

Miloš Vujanović, Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Novi Sad, Serbia
Nina Brkić-Jovanović, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Dalibor Ilić, Center for Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
Zorka Drvendžija, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Biljana Srdić-Galić, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Vesna Turkulov, Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Novi Sad, Serbia; and, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Snežana Brkić, Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Novi Sad, Serbia; and, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Daniela Marić, Clinical Centre of Vojvodina, Clinic for Infectious Diseases, Novi Sad, Serbia; and, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia


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Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.

Objectives: The aim of this study was to explore visceral fat thickness (VFT) and anthropometric measurements associated with the development of NAFLD in patients mono-infected with HIV and on long-standing combination antiretroviral therapy (cART).

Method: Eighty-eight (n = 88) HIV-positive male patients, average age 39.94 ± 9.91 years, and stable on cART, were included in this prospective study. VFT was measured using ultrasonography. Anthropometric measurements included body mass index (BMI), waist-to-hip ratio (W/H), waist-to-height ratio (WHtR), waist and hip circumference (WC, HC). Differences between variables were determined using the chi-square test. The receiver operating characteristic (ROC) curve and the Youden index were used to determine optimal cut-off values of VFT and hepatic steatosis. The area under the curve (AUC), 95% confidence intervals, sensitivity and specificity are reported for the complete sample. Significance was set at p < 0.05.

Results: Patients with steatosis had significantly higher values of BMI, HC, WC, W/H and WHtR. The VFT was higher in patients with steatosis (p < 0.001). Specifically, VFT values above 31.98 mm and age > 38.5 years correlated with steatosis in HIV-positive patients, namely sensitivity 89%, specificity 72%, AUC 0.84 (95% CI, 0.76–0.93, p < 0.001), with the highest Youden index = 0.61. The sensitivity of the age determinant above this cut-off point was 84%, specificity 73% and AUC 0.83 (95% CI, 0.75–0.92, p < 0.001), with the highest Youden index of 0.57.

Conclusion: In the absence of more advanced radiographic and histological tools, simple anthropometric measurements and VFT could assist in the early identification of persons at risk of hepatic steatosis in low- and middle-income regions.


Keywords

Non-alcoholic fatty liver disease; HIV mono-infection; Hepatic steatosis; Ultrasonography; Anthropometric measurements

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