Risk of Adverse cardiovascular outcomes among persons living with HIV and nonalcoholic fatty liver disease: a multicenter matched cohort study.

OBJECTIVE: To examine and compare the risk of major adverse cardiovascular events (MACE) between persons living with HIV (PLWH) with and without nonalcoholic fatty liver disease (NAFLD).

DESIGN: Population-based, multicenter, retrospective cohort study.

METHODS: Data on PLWH between January 1, 2008, and December 31, 2020 were extracted from the TriNetX database. Primary outcomes were defined as the first incidence of myocardial infarction (MI), MACE, new-onset heart failure (HF), and a composite of cerebrovascular disease. Cox models were used to obtain hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS: A total of 151,868 patients were identified as having HIV. After exclusions, 4969 patients were identified as having NAFLD. Of them, 4463 (90%) were propensity matched to a non-NAFLD control. Patients with NAFLD were older(42.9 vs. 40.8 years). Among the NAFLD cohort, most participants were male and had a smoking history (12.3% vs. 9.8%) than non-NAFLD. The mean follow-up was 4.8 ± 1.1 years for the NAFLD group and 5.3 ± 1.2 years for the non-NAFLD group. The risk of all outcomes was statistically significantly higher in NAFLD patients compared to those without NAFLD: MI (HR, 1.49, 95% CI, 1.11-2.01) MACE (HR, 1.49, 95% CI, 1.25-1.79), HF (HR, 1.73, 95% CI 1.37 - 2.19) and, cerebrovascular diseases (HR, 1.25, 95% CI, 1.05-1.48) and sensitivity analysis showed similar magnitude to the one generated in the primary analysis.

CONCLUSIONS: Patients with NAFLD have an elevated risk of cardiovascular events. The results indicate the need for targeted efforts to improve awareness of CVEs risk in PLWH with NAFLD.