학술논문
Impact of steatotic liver disease and non‐alcoholic steatohepatitis on cognitive impairment in people living with HIV: A cross‐sectional study.
Document Type
Article
Author
Han, Win Min; Hiransuthikul, Akarin; Holroyd, Kathryn B.; Apornpong, Tanakorn; Lwin, Hay Mar; Gatechompol, Sivaporn; Ubolyam, Sasiwimol; Kerr, Stephen; Avihingsanon, Anchalee; Phanuphak, Praphan; Ruxrungtham, Kiat; Lwin, Hay Mar Su; Woratanarat, Kobchoke; Wichiansan, Thanathip; Boonrungsirisap, Jedsadakorn; Kerr, Stephen J; Sophonphan, Jiratchaya; Phonphithak, Supalak; Wongvoranet, Chuleeporn; Chaiyahong, Prachya
Source
Subject
*COGNITION disorder risk factors
*HIV-positive persons
*CONFIDENCE intervals
*CROSS-sectional method
*MULTIPLE regression analysis
*MULTIVARIATE analysis
*NON-alcoholic fatty liver disease
*RISK assessment
*DESCRIPTIVE statistics
*RESEARCH funding
*ODDS ratio
*DISEASE complications
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Language
ISSN
1464-2662
Abstract
Introduction: The link between fatty liver diseases and cognitive impairment among people living with HIV (PLWH) remains unclear. We investigated the association of steatotic liver disease (SLD), advanced liver fibrosis and non‐alcoholic steatohepatitis (NASH) with significant activity and liver fibrosis with cognitive impairment in PLWH. Methods: Cognitive performance was assessed for PLWH aged ≥50 years on stable antiretroviral therapy (ART) with the Thai‐validated version of the Montreal Cognitive Assessment (MoCA), and a cut‐off of <25/30 was used to define cognitive impairment. SLD and NASH with significant activity and liver fibrosis were defined as having a controlled attenuation parameter value ≥248 dB/m and a FibroScan‐AST (FAST) score ≥0.67, respectively. Multivariable logistic regression was employed to investigate the association of cognitive impairment with SLD or NASH. Results: Of the 319 PLWH (63.3% male and 98% had HIV‐1 RNA ≤50 copies/mL) included, 74 (38%) had SLD. NASH with significant activity and liver fibrosis was present in 66 (20.1%) participants. Some 192 (60.2%) participants had cognitive impairment. In a multivariable analysis, NASH with significant activity and liver fibrosis was significantly associated with cognitive impairment (adjusted odds ratio [aOR] 2.01, 95% CI 1.02–3.98, p = 0.04), after adjusting for HIV‐related parameters, age, sex, body mass index, employment status, education, income level, smoking, alcohol use, diabetes mellitus, hypertension and HIV‐related parameters. The association of a lone diagnosis of SLD and cognitive impairment was not statistically significant. Conclusions: NASH with significant activity and liver fibrosis was associated with lower cognitive performance, even after controlling for demographics and HIV disease parameters. Additional research is needed to better understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]