Effects of Food Insecurity on Hepatic Steatosis and Fibrosis in People With HIV

Ani Kardashian; Audrey Lloyd; Eduardo Vilar-Gomez; Susanna Naggie; Mark S Sulkowski; Tinsay Woreta; Jordan E Lake; Holly Crandall; Rohit Loomba; Laura A Wilson; Richard K Sterling; Sonya Heath; Samer Gawrieh; Naga P Chalasani; Jennifer C Price; HIV NASH Clinical Research Network

doi:10.1016/j.cgh.2024.03.017

Effects of Food Insecurity on Hepatic Steatosis and Fibrosis in People With HIV

Clin Gastroenterol Hepatol. 2024 Apr 5:S1542-3565(24)00299-4. doi: 10.1016/j.cgh.2024.03.017. Online ahead of print.

Authors

Collaborators

HIV NASH Clinical Research Network:
Susanna Naggie¹³, Anna Mae Diehl¹³, Mariko Kopping¹³, Rebecca Mangus¹³, Naga Chalasani¹⁴, Kaelea Cheek¹⁴, Holly Crandall¹⁴, Oscar W Cummings¹⁴, Nicole Garcia¹⁴, Samer Gawrieh¹⁴, Montreca Releford¹⁴, Eduardo Vilar-Gomez¹⁴, Mark Sulkowski¹⁵, Sherilyn Brinkley¹⁵, Daniel Coleman¹⁵, Lee Gilman¹⁵, Sara Mekhael¹⁵, Juhi Moon¹⁵, Lauren Stelmash¹⁵, Quintara Williams¹⁵, Tinsay Woreta¹⁵, Sonya L Heath¹⁶, Paul A Goepfert¹⁶, Meagan Gray¹⁶, Olivia Hogue¹⁶, Audrey Lloyd¹⁶, Heather Logan¹⁶, Kristen Spraggins¹⁶, William Tingle¹⁶, Latasha Vereen¹⁶, Rohit Loomba¹⁷, Veeral Ajmera¹⁷, Edward Cachay¹⁷, Vanessa Cervantes¹⁷, Christie Hernandez¹⁷, Egbert Madamba¹⁷, Lisa Richards¹⁷, Kaleb Tesfai¹⁷, Monica Tincopa¹⁷, Jennifer Price¹⁸, Rosaura Camberos¹⁸, Yesenia Laguardia¹⁸, Annie Luetkemeyer¹⁸, Jeffrey McKinney¹⁸, Brittlyn Pearlman¹⁸, Sophie Stern¹⁸, Jordan E Lake¹⁹, Marisel Negret Hernandez¹⁹, Anoma Somasunderam¹⁹, Richard Sterling²⁰, Megan Devore²⁰, Daniel Nixon²⁰

Affiliations

¹ Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California.
² Division of Infectious Diseases, Department of Medicine and Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
³ Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
⁴ Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
⁵ Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁶ University of Texas Health Science Center at Houston, Houston, Texas.
⁷ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, San Diego, California.
⁸ Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
⁹ Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia.
¹⁰ Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama.
¹¹ Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health, Indianapolis, Indiana.
¹² Department of Medicine, University of California, San Francisco, San Francisco, California. Electronic address: Jennifer.Price@ucsf.edu.
¹³ Duke University, Durham, NC.
¹⁴ Indiana University, Indianapolis, IN.
¹⁵ Johns Hopkins University, Baltimore, MD.
¹⁶ University of Alabama, Birmingham, AL.
¹⁷ University of California San Diego, La Jolla, CA.
¹⁸ University of San Francisco, San Francisco, CA.
¹⁹ University of Texas Health Science Center (UTHealth) Houston, Houston, TX.
²⁰ Virginia Commonwealth University, Richmond, VA.

PMID: 38582290
DOI: 10.1016/j.cgh.2024.03.017

Abstract

Background & aims: Food insecurity (FI) is a risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis in the general population, but its impact on liver disease in people with HIV (PWH) is unknown.

Methods: We examined the association of FI with prevalence of NAFLD and fibrosis in a diverse cohort of PWH. PWH aged ≥ 18 years on antiretroviral therapy, HIV RNA <200 copies/mL, and without other known liver diseases were screened for NAFLD (controlled attenuated parameter ≥263 decibels/meter) and advanced fibrosis (liver stiffness measurement ≥11 kilopascals) by vibration controlled transient elastography at 8 U.S.

Centers: Participants were categorized as food insecure using the Six-Item Short Form Household Food Security Survey. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NAFLD and advanced fibrosis by FI status.

Results: Among 654 PWH, NAFLD was present in 348 (53%) and advanced fibrosis in 41 (6%). FI was present in 203 of participants (31%), including 97/348 with NAFLD (28%) and 18/41 with advanced fibrosis (44%). In multivariable analysis, FI was associated with lower odds of NAFLD (OR, 0.57; 95% CI, 0.37-0.88) and a greater, but nonsignificant, odds of advanced fibrosis (OR, 1.38; 95% CI, 0.65-2.90). We identified a significant interaction between FI and diabetes (P = .02) on fibrosis risk, with greater odds of fibrosis among food insecure PWH and diabetes (OR, 3.83; 95% CI, 1.15-12.73) but not among food insecure nondiabetics (OR, 1.12; 95% CI, 0.47-2.98).

Conclusions: FI is highly prevalent among PWH and associated with lower odds of NAFLD, and among PWH with diabetes, there is greater odds of advanced fibrosis. FI may contribute to hepatic fibrosis through mechanisms other than steatosis in PWH.

Keywords: AIDS; Fatty Liver; Food Security; HIV; Liver Disease; Liver Health Outcomes; MASLD; Social Determinants of Health.

Grants and funding

R01 DK121378/DK/NIDDK NIH HHS/United States