Day 3 CROI:
I am sure all the General Practitioners reading this topic are much more familiar with the management of patients with this condition than I am.
Dr Rohit Loomba is a Gastroenterologist/Hepatologist at University of California, San Diego and he presented current work he, and colleagues, are undertaking in imaging and monitoring patients long term with NAFLD (Non- Alcoholic Fatty Liver Disease) and progression to NASH (Non-Alcoholic Steatohepatitis): Defined as >5% fatty infiltration on liver biopsy with pathognomonic ballooning of hepatocytes. NASH is now the second cause of liver transplantation in California.
NAFLD is divided into NAFL (non-progressive over many decades) and NASH (rapidly progressive over 7-8 years with a high mortality rate).
Some of the identifying clues to a patient with NAFLD are: Metabolic Syndrome, Diabetes mellitus, older age, high AST/ALT, low platelets and low albumin. For these patients consider Hepatologist assessment for liver biopsy and appropriate imaging.
We are all aware that patients with HIV have increasing mortality due to liver disease. Dr Loomba indicated that NASH is 30-40% higher in patients with HIV infection and is independent of age, sex and BMI. He is currently looking at appropriate imaging strategies for NASH which monitor impact on pericardial fat and loss of muscle mass with progressive NASH. Sarcopenia is associated with increased mortality. His unit is also currently undertaking trials with a new medication Aramchol together with lifestyle intervention and weight loss strategies
TAKE HOME MESSAGE: We all need to be more proactive in assessing HIV infected patients with “fatty infiltration” of the liver on ultrasound especially if they have other associated clinical parameters.