Dissertations & Theses (Open Access)

Date of Award

Spring 5-5-2023

Degree Name

Doctor of Philosophy in Nursing (PhD)


Geri LoBiondo-Wood, Ph.D

Second Advisor

Stacey Crane, Ph.D

Third Advisor

Diane M. Santa Maria, DrPH

Fourth Advisor

Osaro Mgbere, Ph.D


Background: Nonalcoholic fatty liver disease (NAFLD) disproportionately affects up to 75% of people living with HIV (PLWH). Given the high HIV prevalence in Houston and Harris County, knowledge of the prevalence of NAFLD in PLWH is needed to inform prevention efforts. In addition, such knowledge is required to raise awareness among at-risk individuals and healthcare professionals.

Specific Aims: This cross-sectional study aimed (1) to examine the demographic, behavioral, clinical, and psychosocial characteristics of PLWH in Houston/Harris County, Texas, and to estimate the prevalence of NAFLD, (2) to determine factors associated with the severity of NAFLD, and (3) to identify specific predictors and their contribution to the severity of the disease in this population.

Methods: The Triglyceride Glucose Index with a cutoff value of > 8.38 was applied in a sample of PLWH (N = 601) obtained from the 2015-2019 Houston Medical Monitoring Project. Descriptive statistics and Rao-Scott Chi-Square tests were used to estimate the prevalence of NAFLD. Demographic, behavioral, clinical, and psychosocial characteristics were reported with weighted frequencies, percentages, and 95% confidence interval (CI). Multivariable logistic regression models were utilized to identify predictors. In addition, a recursive partitioning analysis was conducted to determine which predictors contributed to NAFLD severity.

Results: Overall, the prevalence of NAFLD was 98.20%. The prevalence was higher among individuals 50 years and older, males, and Black PLWH, but the differences were not statistically significant. In the bivariate analyses, exposure to integrase strand transfer inhibitor was significantly associated with the presence of NAFLD (p = 0.0376). In the multivariable models, PLWH exposed to non-nucleoside reverse transcriptase inhibitors had higher odds, with unreliable confidence intervals (aOR = 15.78; 95% CI: 1.15 – 216.69, p = 0.0392). Time since HIV diagnosis (aOR = 3.64; 95% CI: 1.48 – 8.93, p = 0.0050), and Hispanic ethnicity (aOR = 3.13, 95% CI: 1.21 – 8.13, p = 0.0191), predicted severe NAFLD. In recursive partitioning models, race/ethnicity, exposure to non-nucleoside reverse transcriptase inhibitor, and time since HIV diagnosis contributed 51%, 24%, and 33–49%, respectively, to NAFLD severity.

Conclusion: Early and prompt care of NAFLD, particularly liver fibrosis, will reduce the prevalence of the disease and save lives. Providers should, therefore, closely monitor, screen, and counsel PLWH with these identified risk factors and refer them to a liver specialist.


NAFLD, PLWH, HIV, Triglyceride glucose index

Included in

Nursing Commons



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