Zobair M. Younossi
VIENNA — As HIV reaches new levels of control and hepatitis C virus treatments give cures, providers must be aware that non-alcoholic fatty liver disease is on the rise in the population with HIV as it is in the general population.
“As you normalize these patients’ health by suppressing HIV and by curing HCV, they become healthier and that healthier profile in the U.S. is to become more obese and more diabetic. That is also true of HCV patients who don’t have HIV. As we cure them, a third of those patients if you rebiopsy them after HCV cure, they have underlying NAFLD,” Zobair M. Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital, Fairfax, Virginia, said during a press conference at the International Liver Congress. “In the future, we will probably treat these patients the same as anyone else whether they have HCV or NAFLD. You need to pay attention to this and treat them the same way.”
This study looked at more than 47,000 patients with HIV infection who received Medicare in the United States, identifying 10,474 patients with liver disease (22.3%) based on ICD-9 and ICD-10 codes. Of those with liver disease, 2,629 had NAFLD.
From 2006 to 2016, Younossi showed that while viral hepatitis prevalence in the population with HIV decreased 0.88% from 27.75 to 24.17 per 100,000 population (P = .009), the rates for NAFLD more than doubled from 5.32 to 11.62 per 100,000 population (P < .001). Mortality rates from these diseases reflected the prevalence changes: mortality from hepatitis decreased 5.21% from 3.78 to 2.58 per 100,000 population (P = .006) while mortality from NAFLD increased 8.97% from 0.18 to 0.8 per 100,000 (P = .041).
“Over the last decade, prognosis and mortality of HIV with viral hepatitis in the Medicare population has actually decreased and that’s what we are also seeing in the general population with the NHANES dataset,” Younossi said. “The incidence and mortality of HIV with NAFLD is increasing.”
The data showed that compared with patients with HIV but without liver disease, those patients with HIV and liver disease had higher risk for 1-year mortality, longer length of hospital stay and greater inpatient and outpatient costs (P < .05 for all).
“In the Medicare dataset, liver disease is associated with mortality and resource utilization independent of all the other comorbidities taken into account in the multivariate analysis.
Given this data, clinicians and providers really must be vigilant in to identify and manage HIV who happen to have liver disease,” Younossi said. – by Katrina Altersitz
Younossi Z. PS-062. Presented at: International Liver Congress; April 10-14, 2019; Vienna, Austria.
Disclosures: Younossi has received consulting fees from Gilead, Intercept, Bristol-Myers Squibb, Novo Nordisk, Shinogi and Novartis. Sila Cocciolillo has no relevant disclosures.