Previous studies have found that patients coinfected with both HIV and hepatitis C virus (HCV) at higher risk of metabolic complications and liver-related events, both associated with hepatic steatosis and non-alcoholic steatohepatitis (NASH). The authors were interested in whether the fatty liver index (FLI), a non-invasive steatosis biomarker, can be used in HIV-HCV coinfected patients. They analysed data from 983 patients, covering 4432 visits, to see if an elevated FLI (≥60) is associated with all-cause mortality. The authors found that patients with FLI≥60 had almost double the risk of all-cause mortality (adjusted hazard ratio [aHR] 1.91, 95%CI 1.17-3.12), independently of: HCV cure (aHR 0.21, 95%CI 0.07-0.61), advanced fibrosis (aHR 1.77, 95%CI 1.00-3.14), history of hepatocellular carcinoma and/or liver transplantation (aHR 7.74, 95%CI 3.82-15.69), history of indirect clinical signs of cirrhosis (aHR 2.80, 95%CI 1.22-6.41), and HIV CDC clinical stage C (aHR 2.88, 95%CI 1.74-4.79). Therefore an elevated fatty liver index (FLI≥60) is a risk factor for all-cause mortality in HIV-HCV coinfected patients, independently of liver fibrosis and HCV cure.
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