Impact of nonalcoholic fatty liver disease on clinical outcomes in patients with COVID-19 among persons living with HIV: A multicenter research network study

https://doi.org/10.1016/j.jiph.2023.02.008Get rights and content
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Abstract

Background

People living with human immunodeficiency virus (PLWH) are at an increased risk of nonalcoholic fatty liver disease (NAFLD) but how these patients react to COVID-19 infection is unclear. We examined the clinical characteristics and outcomes of patients with and without nonalcoholic fatty liver disease (NAFLD) among people living with human immunodeficiency virus (PLWH) diagnosed with COVID-19.

Methods

A multicenter, retrospective cohort study was conducted using TriNetX. Participants diagnosed with COVID-19 between January 20, 2020, and October 31, 2021, in PLWH were identified and divided into cohorts based on preexisting NAFLD. The primary outcome was all-cause mortality, and secondary outcomes were hospitalization, severe disease, critical care, need for mechanical ventilation, and acute kidney injury(AKI). Propensity score matching (PSM) mitigated the imbalance among group covariates. Risk ratios (RR) with 95 % confidence intervals (CI) were calculated.

Results

Of the 5012 PLWH identified with confirmed COVID-19 during the study period, 563 had a diagnosis of NAFLD. After PSM, both groups were well-matched with 561 patients. The primary outcome did not differ between the cohorts at 30-days, even after a fully adjusted analysis, and the risk of all-cause mortality did not differ at 60 and 90 days. NAFLD had a significantly higher risk for hospitalization rates (RR 1.32; 95 % CI, 1.06–1.63) and AKI (RR 2.55; 95 % CI 1.42–4.57) than the non-NAFLD group at 30 days. No other differences were detected in other secondary outcome measures.

Conclusions

Preexisting NAFLD is associated with an increased risk for hospitalization and AKI among PLWH infected with COVID-19. The potential role of NAFLD in developing severe COVID-19 among PLWH remains to be elucidated in future studies. Still, this study indicates the need for careful monitoring of this at-risk population.

Abbreviations

PLWH
Persons living with human immunodeficiency virus
HIV
human immunodeficiency virus
NAFLD
nonalcoholic fatty liver disease
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
COVID-19
Coronavirus disease 2019
HT
Hypertension
T2DM
type 2 diabetes mellitus
HF
heart failure
BMI
Body mass index
ALT
Alanine aminotransferase
ALP
Alkaline phosphatase
AST
Aspartate aminotransferase
BUN
Blood urea nitrogen
CI
Confidence interval
CRP
C-reactive protein
GGT
Gamma-glutamyl transpeptidase
RR
Risk ratios
PT
Prothrombin time
SD
Standard deviations
T-Bil
Total bilirubin
LDH
Lactate dehydrogenase
NNRTIs
non-nucleoside reverse transcriptase inhibitors
NRTIs
nucleoside reverse transcriptase inhibitors
CD
cluster of differentiation
RNA
ribonucleic acid

Keywords

SARS-CoV-2
COVID-19
HIV
Non-alcohol fatty liver disease
NAFLD
Outcomes
Mortality
Fatty liver disease
Syndemic
Health care

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