Impact of nonalcoholic fatty liver disease on clinical outcomes in patients with COVID-19 among persons living with HIV: A multicenter research network study. Issue 5 (May 2023)

• Record Type: Journal Article
• Authors: Krishnan, Arunkumar; Woreta, Tinsay A.; Sims, Omar T.; Hamilton, James P.; Potter, James J.; Alqahtani, Saleh A.
• Is Part Of: Journal of infection and public health. Volume 16:Issue 5(2023)
• Page Start: 673
• Page End: 679
• Publication Date: 2023-05
• Subjects: PLWH Persons living with human immunodeficiency virus -- HIV human immunodeficiency virus -- NAFLD nonalcoholic fatty liver disease -- SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 -- COVID-19 Coronavirus disease 2019 -- HT Hypertension -- T2DM type 2 diabetes mellitus -- HF heart failure -- BMI Body mass index -- ALT Alanine aminotransferase -- ALP Alkaline phosphatase -- AST Aspartate aminotransferase -- BUN Blood urea nitrogen -- CI Confidence interval -- CRP C-reactive protein -- GGT Gamma-glutamyl transpeptidase -- RR Risk ratios -- PT Prothrombin time -- SD Standard deviations -- T-Bil Total bilirubin -- LDH Lactate dehydrogenase -- NNRTIs non-nucleoside reverse transcriptase inhibitors -- NRTIs nucleoside reverse transcriptase inhibitors -- CD cluster of differentiation -- RNA ribonucleic acid; SARS-CoV-2 -- COVID-19 -- HIV -- Non-alcohol fatty liver disease -- NAFLD -- Outcomes -- Mortality -- Fatty liver disease -- Syndemic -- Health care; Communicable diseases -- Periodicals; Public health -- Periodicals; Epidemiology -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Medical microbiology -- Periodicals; 614.4
• DOI: 10.1016/j.jiph.2023.02.008
• Languages: English
• ISSNs: 1876-0341

Abstract

Abstract: Background: People living with human immunodeficiency virus (PLWH) are at an increased risk of nonalcoholic fatty liver disease (NAFLD) but how these patients react to COVID-19 infection is unclear. We examined the clinical characteristics and outcomes of patients with and without nonalcoholic fatty liver disease (NAFLD) among people living with human immunodeficiency virus (PLWH) diagnosed with COVID-19. Methods: A multicenter, retrospective cohort study was conducted using TriNetX. Participants diagnosed with COVID-19 between January 20, 2020, and October 31, 2021, in PLWH were identified and divided into cohorts based on preexisting NAFLD. The primary outcome was all-cause mortality, and secondary outcomes were hospitalization, severe disease, critical care, need for mechanical ventilation, and acute kidney injury(AKI). Propensity score matching (PSM) mitigated the imbalance among group covariates. Risk ratios (RR) with 95 % confidence intervals (CI) were calculated. Results: Of the 5012 PLWH identified with confirmed COVID-19 during the study period, 563 had a diagnosis of NAFLD. After PSM, both groups were well-matched with 561 patients. The primary outcome did not differ between the cohorts at 30-days, even after a fully adjusted analysis, and the risk of all-cause mortality did not differ at 60 and 90 days. NAFLD had a significantly higher risk for hospitalization rates (RR 1.32; 95 % CI, 1.06–1.63) and AKI (RR 2.55; 95 % CI 1.42–4.57) than the non-NAFLD group at 30 days. No other differences were detected in other secondary outcome measures. Conclusions: Preexisting NAFLD is associated with an increased risk for hospitalization and AKI among PLWH infected with COVID-19. The potential role of NAFLD in developing severe COVID-19 among PLWH remains to be elucidated in future studies. Still, this study indicates the need for careful monitoring of this at-risk population.