The impact of cART on hepatic steatosis and fibrosis in treatment-naïve PLwHIV: A prospective cohort study

Background We aimed to determine the effect of combined antiretroviral therapy (cART) on hepatic steatosis and fibrosis in people living with human immunodeficiency virus (PLwHIV). Methods In this single-center and prospective cohort study, PLwHIV were evaluated longitudinally by transient elastography at the initiation and 7 months (±1 month) after the cART. Results Of the 81 PLwHIV, 28.3% had hepatic steatosis, 40.7% had fibrosis (≥F1), and 24.7% had significant fibrosis (≥F2). In multivariate analysis, body mass index (BMI) ( p = .005) and albumin ( p = .045) were independent predictors for hepatic steatosis, while aspartate aminotransferase (AST) ( p = .041) was an independent predictor for hepatic fibrosis. Control transient elastography was performed in 66 (81.5%) PLwHIV after treatment. Among these patients, the rate of hepatic fibrosis decreased significantly after treatment (43.9% vs 24.2%, p = .017). In the tenofovir alafenamide (TAF)-based regimen, weight ( p < .001), BMI ( p < .001), waist circumference ( p < .001), and total cholesterol ( p = .012) increased, while kPA value ( p = .002) decreased. In the tenofovir disoproxil fumarate (TDF)-based regimen, controlled attenuation parameter (CAP) value ( p = .017) and waist circumference ( p = .006) increased. In the lamivudine (LAM)-based regimen, there was no statistically significant change (p > .05). Conclusion Hepatic fibrosis regressed with antiretroviral treatments (especially with TAF-based), while the degree of hepatosteatosis progressed (especially with TDF-based). Additionally, weight gain occurred after cART in PLwHIV (especially with TAF-based). Therefore, hepatic steatosis and weight gain in PLwHIV should not be disregarded. In conclusion, PLwHIV on cART need close follow-up for the development of metabolic complications.