Noninvasive Markers of Hepatic Steatosis and Fibrosis Following Integrase Strand-Transfer Inhibitor Initiation in Women With HIV

Abstract Background The impact of integrase strand-transfer inhibitors (INSTIs) on steatotic liver disease in women with HIV (WWH) is unknown. Methods Using data collected in the Women's Interagency HIV Study from 2007–2020, change in Fibrosis-4 index (FIB4), aspartate aminotransferase to platelet ratio index (APRI), and nonalcoholic fatty liver disease fibrosis score (NFS) over 5 years was compared between virologically suppressed WWH who switched to or added an INSTI to their antiretroviral therapy (ART) and WWH remaining on non-INSTI ART. In participants with transient elastography (TE) measures, estimates of hepatic steatosis (controlled attenuation parameter [CAP]), fibrosis (liver stiffness [LS]), and steatohepatitis (FibroScan-aspartate aminotransferase [FAST] scores) were compared by group. Results A total of 872 WWH (323 INSTI, 549 non-INSTI) were included, and 280 (146 INSTI, 134 non-INSTI) had TE. Of these, 61% were non-Hispanic Black; mean age was 47 years and body mass index was 31.4 kg/m2. Among non-obese women, those in the INSTI versus non-INSTI group had a greater increase in NFS (but not FIB4 or APRI) over time (study group × time, P = .015). Those in the INSTI versus non-INSTI group also had greater CAP (+25; 95% CI: .28–49; P = .048), LS (+1.23; 1.01–1.49; P = .038), and FAST scores (+1.97; 1.17–3.31; P = .011) and a 3.7 (1.2–11.4; P = .021) greater odds of having hepatic steatosis (CAP ≥248 dB/m) within 1 year of starting an INSTI. Conclusions Hepatic steatosis risk was increased only within the first year following INSTI initiation among WWH. Longitudinal hepatic assessments are warranted to evaluate whether these changes are associated with clinically significant liver disease.