Fatty Liver Screening Gaps Emerge in HIV Care Survey

TOPLINE:

Two thirds of HIV care providers surveyed screen for nonalcoholic fatty liver disease (NAFLD) in patients with HIV (PWH). The main barriers to fatty liver screening are uncertainty about tests, insufficient diagnostic data, low priority, time constraints, and lack of referrals.

METHODOLOGY:

• Guidance on NAFLD lacks specific considerations for PWH. A survey of US HIV providers of the American Academy of HIV Medicine assessed their screening practices and management needs.
• An online 16-question anonymous survey was sent to member and nonmember HIV providers of the American Academy of HIV Medicine three times over 6 weeks from January to February 2023.
• The survey assessed NAFLD referral and screening practices, barriers to screening, and attitude toward hypothetical support tools for NAFLD diagnosis and management.
• A total of 214 respondents, including physicians (60%), nurse practitioners (28%), and physician assistants (12%), participated.

TAKEAWAY:

• Primary care practitioners dominated the respondent pool, with 38% in family practice, 24% in internal medicine, and 28% in infectious diseases; the majority had over 10 years of experience.
• Two thirds of participants reported screening PWH for NAFLD, with persistently elevated liver enzymes (89%), metabolic syndrome (64%), obesity (61%), and prediabetes/diabetes (56%) being the primary reasons for screening.
• The most preferred methods of screening were testing for liver enzymes and abdominal ultrasound, with only one third using vibration-controlled transient elastography and even fewer using MRI.
• Overall, 64% of participants reported barriers to NAFLD screening, with the major ones being uncertainty about which tests to order (28%) and determining whether there are sufficient diagnostic data (29%), low priority (17%), time constraints (7%), or lack of hepatology referrals (7%).

IN PRACTICE:

“Our findings underscore the need for NAFLD clinical practice guidelines aimed for HIV providers, increased education on NAFLD among PWH, and the inclusion of PWH in NAFLD/NASH [nonalcoholic steatohepatitis] therapeutic trials of novel agents,” the authors wrote.

SOURCE:

The study was led by Jennifer C. Price, MD, PhD, Division of Gastroenterology and Hepatology, University of California, San Francisco. It was published online on December 24, 2024, in the Journal of the Association of Nurses in AIDS Care.

LIMITATIONS:

The major limitation was that the participants were not assessed on their awareness of the existing American Association for the Study of Liver Diseases guidance on NAFLD.

DISCLOSURES:

This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Four authors reported receiving research grants and consulting fees and having stock and stock options or equity ownership in various pharmaceutical organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.