Food insecurity (FI) is a risk factor for nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis in the general population, but its impact on liver disease in people with HIV (PWH) is unknown. We examined the association of FI with prevalence of NAFLD and fibrosis in a diverse cohort of PWH. PWH aged 18 years on antiretroviral therapy, HIV RNA <200 copies/mL, and without other known liver diseases were screened for NAFLD (controlled attenuated parameter ≥263 decibels/meter) and advanced fibrosis (liver stiffness measurement ≥11 kilopascals) by vibration controlled transient elastography at 8 U.S. centers. Participants were categorized as food insecure using the Six-Item Short Form Household Food Security Survey. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NAFLD and advanced fibrosis by FI status. Among 654 PWH, NAFLD was present in 348 (53%) and advanced fibrosis in 41 (6%) FI was present in 203 of participants (31%), including 97/348 with NAFLD (28%) and 18/41 with advanced fibrosis (44%). In multivariable analysis, FI was associated with lower odds of NAFLD (OR, 0.57; 95% CI, 0.37–0.88) and a greater, but nonsignificant, odds of advanced fibrosis (OR, 1.38; 95% CI, 0.65–2.90). We identified a significant interaction between FI and diabetes ( = .02) on fibrosis risk, with greater odds of fibrosis among food insecure PWH and diabetes (OR, 3.83; 95% CI, 1.15–12.73) but not among food insecure nondiabetics (OR, 1.12; 95% CI, 0.47–2.98). FI is highly prevalent among PWH and associated with lower odds of NAFLD, and among PWH with diabetes, there is greater odds of advanced fibrosis. FI may contribute to hepatic fibrosis through mechanisms other than steatosis in PWH.

中文翻译：

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粮食不安全对艾滋病毒感染者肝脏脂肪变性和纤维化的影响

粮食不安全（FI）是一般人群中非酒精性脂肪性肝病（NAFLD）和晚期纤维化的危险因素，但其对艾滋病毒感染者（PWH）肝病的影响尚不清楚。我们在不同的 PWH 队列中研究了 FI 与 NAFLD 和纤维化患病率的关联。 18 岁接受抗逆转录病毒治疗、HIV RNA <200 拷贝/mL、无其他已知肝脏疾病的 PWH 通过振动控制筛查 NAFLD（受控衰减参数≥263 分贝/米）和晚期纤维化（肝脏硬度测量≥11 千帕）美国 8 个中心的瞬时弹性成像。使用六项简短的家庭粮食安全调查将参与者归类为粮食不安全类别。我们使用多变量逻辑回归来估计 FI 状态下 NAFLD 和晚期纤维化的比值比 (OR) 和 95% 置信区间 (CI)。在 654 名 PWH 中，348 名 (53%) 存在 NAFLD，41 名 (6%) 存在晚期纤维化 203 名参与者 (31%) 存在 FI，其中 97/348 患有 NAFLD (28%)，18/41 患有晚期纤维化纤维化（44%）。在多变量分析中，FI 与 NAFLD 的较低几率相关（OR，0.57；95% CI，0.37-0.88），并且晚期纤维化的几率较高（但不显着）（OR，1.38；95% CI，0.65-2.90）。我们发现 FI 和糖尿病 (= .02) 在纤维化风险方面存在显着的交互作用，粮食不安全的孕产妇和糖尿病患者发生纤维化的可能性更大（OR，3.83；95% CI，1.15–12.73），但粮食不安全的非糖尿病患者则没有出现纤维化的可能性（OR，3.83；95% CI，1.15–12.73） ，1.12；95% CI，0.47–2.98）。 FI 在 PWH 中非常普遍，并且与 NAFLD 的几率较低相关，而在患有糖尿病的 PWH 中，晚期纤维化的几率更大。 FI 可能通过 PWH 中脂肪变性以外的机制导致肝纤维化。