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中低收入国家 HIV 感染中的非传染性疾病:胃肠道、肝脏和营养方面。

Noncommunicable diseases in HIV infection in low- and middle-income countries: gastrointestinal, hepatic, and nutritional aspects.

机构信息

*Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom; †Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; ‡Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa; and §Massachusetts General Hospital, Boston, MA.

出版信息

J Acquir Immune Defic Syndr. 2014 Sep 1;67 Suppl 1(0 1):S79-86. doi: 10.1097/QAI.0000000000000260.

Abstract

The purpose of this review was to outline the interaction between HIV and noncommunicable diseases affecting the gastrointestinal (GI) tract, liver, and nutritional disorders in low- and middle-income countries (LMICs), and to identify research priorities. Noncommunicable GI tract disorders are only moderately influenced by HIV, and peptic ulceration is actually less common. However, the impact of HIV on GI cancers needs further investigation. HIV interacts strongly with environmental enteropathy, exacerbating malabsorption of nutrients and drugs. HIV has 2 major effects on noncommunicable liver disease: drug-induced liver injury and nonalcoholic fatty liver disease (particularly in persons of African genetic descent). The effect of HIV on nutrition was one of the first markers of the epidemic in the 1980s, and HIV continues to have major nutritional consequences. Childhood malnutrition and HIV frequently coexist in some regions, for example, southern Africa, resulting in powerful negative interactions with poorer responses to standard nutritional rehabilitation. HIV and nutritional care need to be better integrated, but many questions on how best to do this remain unanswered. Across the spectrum of GI, hepatic, and nutritional disorders in HIV infection, there is increasing evidence that the microbiome may play an important role in disease pathogenesis, but work in this area, especially in low- and middle-income countries, is in its infancy.

摘要

本次综述旨在概述影响中低收入国家(LMICs)胃肠道(GI)、肝脏和营养障碍的 HIV 与非传染性疾病之间的相互作用,并确定研究重点。非传染性 GI 道疾病仅受 HIV 中度影响,实际上消化性溃疡并不常见。然而,HIV 对 GI 癌症的影响需要进一步研究。HIV 与环境肠病强烈相互作用,加重了营养物质和药物的吸收不良。HIV 对非传染性肝病有 2 个主要影响:药物性肝损伤和非酒精性脂肪肝疾病(特别是在非洲裔遗传血统的人群中)。HIV 对营养的影响是 20 世纪 80 年代该流行病的首批标志之一,HIV 仍然具有重大的营养后果。例如,在南部非洲等一些地区,儿童营养不良和 HIV 经常同时存在,导致对标准营养康复的反应更差,产生强烈的负面相互作用。HIV 和营养护理需要更好地整合,但关于如何最好地做到这一点的许多问题仍未得到解答。在 HIV 感染的整个 GI、肝脏和营养障碍范围内,越来越多的证据表明微生物组可能在疾病发病机制中发挥重要作用,但该领域的工作,尤其是在中低收入国家,仍处于起步阶段。

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