Grant: Project Grant

Nowadays, people living with HIV live longer thanks to the widespread use of antiretroviral treatment (ART). As a direct consequence, they develop aging-related conditions such as diabetes, obesity, hypercholesterolemia. These are risk factors for fatty liver, the most frequent liver disease in Canada, affecting 25% of the general population. Our data indicate that fatty liver is particularly frequent in Canadians living with HIV, affecting up to 48% of patients. This excess is likely due to additional risk factors for liver damage, including ART needed for the whole life and inflammation caused by HIV. However, it is not known if fatty liver evolves to more advanced stages of liver disease and liver failure in HIV+ persons and who is at higher risk for these important complications. As a consequence, HIV+ patients are excluded from global clinical trials of new medications to treat fatty liver. Our team has championed the non-invasive method Fibroscan equipped with a special software for the quantification of fat in the liver (controlled attenuation parameter, CAP). This patient-friendly test can accurately and safely diagnose fatty liver with no need for liver biopsy, which can be painful and has complications. We will follow 968 HIV+ patients from 4 major HIV clinical centres with Fibroscan with CAP for 4 years. We will determine how many patients with fatty liver develop advanced stages of liver disease and liver failure. We will also study the contribution of important risk factors for advanced liver disease, such as ART, obesity, insulin resistance, sex. These factors will be used to develop a risk score aimed at identify HIV+ persons at higher risk for these important complications. Our ultimate aim is to determine the impact of fatty liver on advanced liver disease in HIV+ patients in order to advocate for their inclusion in new clinical trials for fatty liver and for clinical strategies to identify those at high risk of developing advanced liver disease.