Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA.
Lancet Gastroenterol Hepatol. 2017 Mar;2(3):211-223. doi: 10.1016/S2468-1253(16)30120-0. Epub 2017 Feb 9.
Liver disease is a leading cause of morbidity and mortality among people with HIV, and in this era of safer and more effective hepatitis C therapy, non-alcoholic fatty liver disease (NAFLD) could soon emerge as the most common liver disease in this population. NAFLD is common among patients with HIV, and might be more likely to progress to non-alcoholic steatohepatitis (NASH) and NAFLD-related fibrosis or cirrhosis in these patients than in individuals without HIV. Several mechanisms of NAFLD pathogenesis are postulated to explain the disease severity in patients with HIV; these mechanisms include the influence of the gut microbiome, and also metabolic, genetic, and immunological factors. Although treatment strategies are currently based on modification of NAFLD risk factors, many new drugs are now in clinical trials, including trials specifically in patients with HIV. Thus, the identification and risk-stratification of patients with HIV and NAFLD are becoming increasingly important for accurately counselling of these patients regarding their prognosis and for establishing the most appropriate disease-altering therapy.
肝脏疾病是 HIV 感染者发病率和死亡率的主要原因，在这个丙型肝炎治疗更安全、更有效的时代，非酒精性脂肪性肝病（NAFLD）可能很快成为这一人群中最常见的肝脏疾病。NAFLD 在 HIV 感染者中很常见，与无 HIV 感染者相比，这些患者更有可能进展为非酒精性脂肪性肝炎（NASH）和与 NAFLD 相关的纤维化或肝硬化。有几种 NAFLD 发病机制的理论来解释 HIV 患者的疾病严重程度；这些机制包括肠道微生物组的影响，以及代谢、遗传和免疫因素。尽管目前的治疗策略基于改变 NAFLD 的危险因素，但许多新药正在临床试验中，包括专门针对 HIV 患者的试验。因此，识别和风险分层 HIV 合并 NAFLD 的患者对于准确为这些患者提供预后咨询以及确定最合适的疾病改变治疗方法变得越来越重要。
