Maurice James B, Patel Amee, Scott Alasdair J, Patel Krish, Thursz Mark, Lemoine Maud
aDepartment of Hepatology, St Mary's Hospital, Imperial College London bGKT School of Medicine, King's College London cDepartment of Surgery, St Mary's Hospital, Imperial College London dBarts and the London School of Medicine and Dentistry, Queen Mary University, London, UK.
AIDS. 2017 Jul 17;31(11):1621-1632. doi: 10.1097/QAD.0000000000001504.
To identify the prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH) and fibrosis in HIV-monoinfected patients.
Systematic review and meta-analysis.
We searched Medline and Embase and included studies that enrolled HIV-monoinfected patients with NAFLD defined by imaging and/or liver histology. Data on prevalence and risk factors for NAFLD, NASH and fibrosis were collected for meta-analysis using random effects models.
Ten studies were included from the United States of America (n = 4), Canada (n = 1), France (n = 2), Italy (n = 1), Japan (n = 1) and China (n = 1). The prevalence of NAFLD (Imaging studies), NASH and fibrosis (biopsied populations) were 35% [95% confidence interval (CI) 29-42], 42% (95% CI 22-64) and 22% (95% CI 13-34), respectively. Meta-analysis of risk factors showed that high BMI, waist circumference, type 2 diabetes, hypertension, triglycerides and high CD4 cell count were associated with NAFLD, whereas HIV viral load, duration of HIV infection, duration of antiretroviral therapy and CD4 cell count nadir were not. Patients with high BMI [mean difference (MD) 1.38, 95% CI 0.04-2.71 P = 0.04], fasting glucose (MD 0.80, 95% CI 0.47-1.13 P < 0.00001) and AST level (MD 13.00, 95% CI 4.34-21.65 P = 0.003) were at increased risk of significant liver fibrosis.
NAFLD is frequently observed in HIV-monoinfected patients, and NASH is a common cause of unexplained abnormal liver function in patients selected for liver biopsy. Metabolic disorders are key risk factors independently of HIV parameters. Future trials on pharmacological interventions in NASH with fibrosis should include patients with HIV.
确定单纯感染人类免疫缺陷病毒（HIV）患者中非酒精性脂肪性肝病（NAFLD）、非酒精性脂肪性肝炎（NASH）及肝纤维化的患病率和危险因素。
系统评价和荟萃分析。
检索Medline和Embase数据库，纳入纳入了经影像学检查和/或肝组织学确诊为NAFLD的单纯HIV感染患者的研究。收集NAFLD、NASH和肝纤维化患病率及危险因素的数据，采用随机效应模型进行荟萃分析。
纳入了来自美国（n = 4）、加拿大（n = 1）、法国（n = 2）、意大利（n = 1）、日本（n = 1）和中国（n = 1）的10项研究。NAFLD（影像学研究）、NASH和肝纤维化（活检人群）的患病率分别为35% [95%置信区间（CI）29 - 42]、42%（95% CI 22 - 64）和22%（95% CI 13 - 34）。危险因素的荟萃分析表明，高体重指数（BMI）、腰围、2型糖尿病、高血压、甘油三酯及高CD4细胞计数与NAFLD相关，而HIV病毒载量、HIV感染持续时间、抗逆转录病毒治疗持续时间及CD4细胞计数最低点与之无关。BMI高[平均差（MD）1.38，95% CI 0.04 - 2.71，P = 0.04]、空腹血糖（MD 0.80，95% CI 0.47 - 1.13，P < 0.00001）及谷草转氨酶（AST）水平（MD 13.00，95% CI 4.34 - 21.65，P = 0.003）的患者发生显著肝纤维化的风险增加。
NAFLD在单纯HIV感染患者中常见，NASH是接受肝活检患者不明原因肝功能异常的常见原因。代谢紊乱是独立于HIV参数的关键危险因素。未来针对NASH合并肝纤维化的药物干预试验应纳入HIV患者。
