Non-invasive identification of severe NAFLD and risk stratification of clinical outcomes using Fibroscan-AST (FAST) score in 1683 people with HIV

Title

Non-invasive identification of severe NAFLD and risk stratification of clinical outcomes using Fibroscan-AST (FAST) score in 1683 people with HIV

Presenter

Giada Sebastiani

Authors

G. Sebastiani * (1), J. Milic (2), D. Kablawi (1), C. Gioe (3), A.S. Al Hinai (1), B. Lebouche (1), A. Benmassaoud (1), M. Deschenes (1), A. Cascio (3), G. Mazzola (3), G. Guaraldi (2)

Institutions

(1) McGill University, Montreal, Canada, (2) University of Modena and Reggio Emilia, Modena, Italy, (3) University of Palermo, Palermo, Italy

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is very frequent in people with HIV (PWH). Guidelines recommend identification of PWH at high risk for NAFLD-related fibrosis and clinical outcomes. The FibroScan-AST (FAST) score was developed to identify patients with nonalcoholic steatohepatitis (NASH) and significant fibrosis, associated with higher risk of end-stage liver disease. We employed the FAST score to identify PWH with severe NAFLD and for risk stratification of clinical outcomes.
METHODS: FibroScan was performed in PWH without viral hepatitis coinfection or alcohol abuse from three large prospective cohorts. We compared prevalence of FAST>0.35 (90% sensitivity and 50% specificity for NASH with significant fibrosis) and FAST'¥0.67 (50% sensitivity, 90% specificity). Incidence of liver-related outcomes (ascites, encephalopathy, variceal bleeding, hepatocellular carcinoma) and extra-hepatic outcomes (cancer, cardiovascular disease) was evaluated by survival analysis. The performance of FAST score in predicting clinical outcomes was compared with simple fibrosis biomarkers.
RESULTS: We included 1683 PWH (mean age 50.1 years, 74.5% male). Prevalence of FAST>0.35 and FAST>0.67 was 8.1% and 1.5%, respectively. At baseline, on multivariable logistic regression higher BMI (aOR 1.15, 95% CI 1.10-1.20), longer duration of HIV infection (aOR 1.05, 95% CI 1.02-1.07), lower CD4 (aOR 0.99, 95% CI 0.99-0.99) and male sex (2.11, 95% CI 1.22-3.65) were associated with FAST >0.35. During a median follow-up of 3.5 years, incidence of liver-related and extra-hepatic outcomes was 7% and 11.5%, respectively. Incidence of liver-related outcomes increased according to FAST score category (see Figure). On multivariable Cox regression analysis, FAST score >0.35 was an independent predictor of liver-related outcomes (aHR 4.44, 95% CI 1.66-11.9). The area under the curve to predict liver-related outcomes was as follows: FAST score 0.83; FIB-4 0.76; NAFLD fibrosis score 0.77; FibroScan 0.78.

CONCLUSIONS: A significant proportion of PWH are at risk for severe NAFLD. FAST score predicts liver-related events and can help risk stratification.

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