Unit of Infectious Diseases, Hospital Universitario de Valme, Seville, Spain.
J Viral Hepat. 2010 Oct;17(10):714-9. doi: 10.1111/j.1365-2893.2009.01229.x.
Transient elastometry (TE) could provide a more accurate evaluation of the frequency and risk factors of liver fibrosis in hepatitis C virus (HCV) infection than that based on biopsy. The aim of this study was to assess the prevalence of and factors associated with significant liver fibrosis in a large population of HIV/HCV-coinfected patients. HIV/HCV-coinfected patients, who had participated in a cross-sectional, multicenter, retrospective study of liver fibrosis using noninvasive markers and in whom a determination of liver stiffness (LS) by TE was available, were included in this analysis. Factors potentially associated with significant fibrosis (LS ≥ 9 kPa) were analyzed. One thousand three hundred and ten patients fulfilled the inclusion criteria, 526 (40%) of them showed LS ≥ 9 kPa and 316 (24%) cirrhosis (LS ≥ 14 kPa). The factors independently associated with significant fibrosis [adjusted odds ratio (95% confidence interval, P value) were the following: older age [1.04 (1.01-1.07), 0.002], daily alcohol intake > 50 g/day [1.58 (1.10-2.27), 0.013] and the length of HCV infection [1.03 (1.00-1.06), 0.023]]. A CD4 cell count lower than < 200 per mm(3) [1.67 (0.99-2.81), 0.053] and HCV genotype 4 [0.66 (0.42-1.02), 0.066] were marginally associated with LS ≥ 9 kPa. In conclusion, the prevalence of cirrhosis in HIV/HCV-coinfected patients seems to be higher than previously reported in studies based on liver biopsy. Older age, alcohol consumption and lower CD4 cell counts are related with significant fibrosis. The latter association supports an earlier starting of antiretroviral therapy in this setting.
瞬时弹性成像（TE）可以比基于活检的方法更准确地评估丙型肝炎病毒（HCV）感染患者的肝纤维化频率和风险因素。本研究的目的是评估大量 HIV/HCV 合并感染患者中显著肝纤维化的流行情况和相关因素。本分析纳入了参与使用非侵入性标志物进行肝纤维化横断面、多中心、回顾性研究且 TE 检测肝硬度（LS）结果可用的 HIV/HCV 合并感染患者。分析了与显著纤维化（LS≥9kPa）相关的潜在因素。符合纳入标准的患者有 1310 例，其中 526 例（40%）LS≥9kPa，316 例（24%）肝硬化（LS≥14kPa）。与显著纤维化相关的独立因素[调整优势比（95%置信区间，P 值）为：年龄较大（1.04（1.01-1.07），0.002）、每日饮酒量>50g/天（1.58（1.10-2.27），0.013）和 HCV 感染时间（1.03（1.00-1.06），0.023]。CD4 细胞计数<200/mm3（1.67（0.99-2.81），0.053）和 HCV 基因型 4（0.66（0.42-1.02），0.066）与 LS≥9kPa 呈边缘相关。总之，HIV/HCV 合并感染患者的肝硬化患病率似乎高于以前基于肝活检的研究报告。年龄较大、饮酒和较低的 CD4 细胞计数与显著纤维化相关。后者的相关性支持在此背景下更早开始抗逆转录病毒治疗。
