Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients

Antonio Cascio, Salvatore Petta, Ghali, Giovanni Guaraldi, Sebastiani, Pembroke, Cocciolillo, Malagoli, Franconi, Guaraldi, Milic, Besutti, Falutz, Adriana Cervo

Risultato della ricerca: Article

Abstract

Objectives: Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to HIV-monoinfected patients. Methods: We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥ 248 dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was < 1.1. Medium/high-risk fibrosis category was defined as fibrosis-4 (FIB-4) ≥ 1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high-risk fibrosis category or having elevated alanine aminotransferase (ALT). Results: A total of 1534 HIV-infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4%) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3%) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79%), elevated ALT (75.9%) and medium/high-risk fibrosis category (75.4%). When the algorithm was extended to these patients, it was found that 341 (32.1%) would require specialist referral to hepatology. Conclusions: According to current guidelines, one in five HIV-monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.
Lingua originaleEnglish
pagine (da-a)96-108
Numero di pagine13
RivistaHIV Medicine
Volume21
Stato di pubblicazionePublished - 2020

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HIV
Guidelines
Gastroenterology
Fibrosis
Comorbidity
Referral and Consultation
Alanine Transaminase
Liver Diseases
Liver
Obesity
Pathology
Non-alcoholic Fatty Liver Disease
Dyslipidemias
Coinfection
Hepatitis
Spleen
Tomography
Alcohols
Hypertension

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

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Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients. / Cascio, Antonio; Petta, Salvatore; Ghali; Guaraldi, Giovanni; Sebastiani; Pembroke; Cocciolillo; Malagoli; Franconi; Guaraldi; Milic; Besutti; Falutz; Cervo, Adriana.

In: HIV Medicine, Vol. 21, 2020, pag. 96-108.

Risultato della ricerca: Article

Cascio, A, Petta, S, Ghali, Guaraldi, G, Sebastiani, Pembroke, Cocciolillo, Malagoli, Franconi, Guaraldi, Milic, Besutti, Falutz & Cervo, A 2020, 'Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients', HIV Medicine, vol. 21, pagg. 96-108.
Cascio, Antonio ; Petta, Salvatore ; Ghali ; Guaraldi, Giovanni ; Sebastiani ; Pembroke ; Cocciolillo ; Malagoli ; Franconi ; Guaraldi ; Milic ; Besutti ; Falutz ; Cervo, Adriana. / Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients. In: HIV Medicine. 2020 ; Vol. 21. pagg. 96-108.
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title = "Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients",
abstract = "Objectives: Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to HIV-monoinfected patients. Methods: We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥&nbsp;248&nbsp;dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was <&nbsp;1.1. Medium/high-risk fibrosis category was defined as fibrosis-4 (FIB-4)&nbsp;≥&nbsp;1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high-risk fibrosis category or having elevated alanine aminotransferase (ALT). Results: A total of 1534 HIV-infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4{\%}) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3{\%}) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79{\%}), elevated ALT (75.9{\%}) and medium/high-risk fibrosis category (75.4{\%}). When the algorithm was extended to these patients, it was found that 341 (32.1{\%}) would require specialist referral to hepatology. Conclusions: According to current guidelines, one in five HIV-monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.",
author = "Antonio Cascio and Salvatore Petta and Ghali and Giovanni Guaraldi and Sebastiani and Pembroke and Cocciolillo and Malagoli and Franconi and Guaraldi and Milic and Besutti and Falutz and Adriana Cervo",
year = "2020",
language = "English",
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pages = "96--108",
journal = "HIV Medicine",
issn = "1464-2662",
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}

TY - JOUR

T1 - Application of guidelines for the management of nonalcoholic fatty liver disease in three prospective cohorts of HIV-monoinfected patients

AU - Cascio, Antonio

AU - Petta, Salvatore

AU - Ghali, null

AU - Guaraldi, Giovanni

AU - Sebastiani, null

AU - Pembroke, null

AU - Cocciolillo, null

AU - Malagoli, null

AU - Franconi, null

AU - Guaraldi, null

AU - Milic, null

AU - Besutti, null

AU - Falutz, null

AU - Cervo, Adriana

PY - 2020

Y1 - 2020

N2 - Objectives: Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to HIV-monoinfected patients. Methods: We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥&nbsp;248&nbsp;dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was <&nbsp;1.1. Medium/high-risk fibrosis category was defined as fibrosis-4 (FIB-4)&nbsp;≥&nbsp;1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high-risk fibrosis category or having elevated alanine aminotransferase (ALT). Results: A total of 1534 HIV-infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4%) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3%) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79%), elevated ALT (75.9%) and medium/high-risk fibrosis category (75.4%). When the algorithm was extended to these patients, it was found that 341 (32.1%) would require specialist referral to hepatology. Conclusions: According to current guidelines, one in five HIV-monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.

AB - Objectives: Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to HIV-monoinfected patients. Methods: We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥&nbsp;248&nbsp;dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was <&nbsp;1.1. Medium/high-risk fibrosis category was defined as fibrosis-4 (FIB-4)&nbsp;≥&nbsp;1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high-risk fibrosis category or having elevated alanine aminotransferase (ALT). Results: A total of 1534 HIV-infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4%) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3%) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79%), elevated ALT (75.9%) and medium/high-risk fibrosis category (75.4%). When the algorithm was extended to these patients, it was found that 341 (32.1%) would require specialist referral to hepatology. Conclusions: According to current guidelines, one in five HIV-monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.

UR - http://hdl.handle.net/10447/387198

UR - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-1293

M3 - Article

VL - 21

SP - 96

EP - 108

JO - HIV Medicine

JF - HIV Medicine

SN - 1464-2662

ER -