Minerva Foundation Institute for Medical Research.
Department of Medicine, University of Helsinki, and Helsinki University Hospital.
Clin Infect Dis. 2020 Apr 10;70(8):1708-1716. doi: 10.1093/cid/ciz435.
Abnormal glucose metabolism and nonalcoholic fatty liver disease (NAFLD) are common in patients with human immunodeficiency virus (HIV+ patients), but longitudinal data are lacking. We determined the natural course of NAFLD (liver fat [LFAT]) and type 2 diabetes mellitus (T2DM) in HIV+ patients with and without lipodystrophy (LD+ and LD-, respectively) during a 16-year longitudinal study.
LFAT (by proton magnetic resonance spectroscopy) and clinical characteristics were measured in 41 HIV+ patients at baseline and after 16 years. Liver fibrosis was estimated by measuring liver stiffness using transient elastography (TE) and magnetic resonance elastography (MRE) at 16 years. We also longitudinally studied 28 healthy subjects.
During follow-up, the HIV+ patients gained more body fat (8.6% ± 0.7%) than the control patients (4.5% ± 0.6%, P < .001). Features of insulin resistance increased significantly in the HIV+ patients but not the control patients. A significant proportion (20%, P < .01 vs 0% at baseline) of the HIV+ but none of the control patients developed T2DM. LFAT was significantly higher at baseline in the LD+ (4.3 [1.9-11.8]) than the LD- (1.0 [0.5-1.5]; P < .001) HIV+ patients. LFAT remained stable during follow-up in all groups. At follow-up, liver stiffness measured with TE was similar among all HIV, LD+, LD-, and control patients and between the LD+ and LD- patients measured with MRE. Advanced fibrosis by MRE was observed in 3 of LD+ and none of LD- patients.
During 16 years of follow-up, progression of NAFLD is rare compared to development of T2DM in HIV+ patients.
异常的葡萄糖代谢和非酒精性脂肪性肝病（NAFLD）在人类免疫缺陷病毒（HIV+）患者中很常见，但缺乏纵向数据。我们在一项 16 年的纵向研究中，确定了伴有和不伴有脂肪营养不良（LD+和 LD-）的 HIV+患者中 NAFLD（肝脂肪[LFAT]）和 2 型糖尿病（T2DM）的自然病程。
在基线和 16 年后，我们测量了 41 名 HIV+患者的 LFAT（通过质子磁共振波谱）和临床特征。在 16 年时，使用瞬时弹性成像（TE）和磁共振弹性成像（MRE）测量肝纤维化。我们还对 28 名健康受试者进行了纵向研究。
在随访期间，HIV+患者比对照组患者（4.5%±0.6%，P<.001）增加了更多的体脂肪（8.6%±0.7%）。HIV+患者的胰岛素抵抗特征显著增加，但对照组患者没有增加。在 HIV+患者中，相当一部分（20%，P<.01，与基线时的 0%相比）发生了 T2DM，但对照组患者中无一例发生。LD+（4.3[1.9-11.8]）的 HIV+患者的 LFAT 基线显著高于 LD-（1.0[0.5-1.5]，P<.001）的 HIV+患者。在所有组中，LFAT 在随访期间均保持稳定。在随访时，TE 测量的肝硬度在所有 HIV、LD+、LD-和对照组患者之间以及在 LD+和 LD-患者之间通过 MRE 测量的肝硬度之间相似。在 3 例 LD+患者中观察到 MRE 进展性纤维化，但在 LD-患者中未见。
在 16 年的随访期间，与 HIV+患者中 T2DM 的发展相比，NAFLD 的进展较为罕见。
