Paik James M, Henry Linda, Golabi Pegah, Alqahtani Saleh A, Trimble Gregory, Younossi Zobair M
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
Center for Outcomes Research in Liver Diseases, Washington, DC, USA.
Open Forum Infect Dis. 2020 Jan 7;7(1):ofz509. doi: 10.1093/ofid/ofz509. eCollection 2020 Jan.
Newer treatments for HIV and hepatitis C virus (HCV) have decreased mortality in HIV/HCV patients. Nonalcoholic fatty liver disease (NAFLD) has increased globally; therefore, the prevalence and mortality of NAFLD among HIV (+) patients was assessed.
Using Medicare denominator, inpatient, and outpatient files (random 5% sample per year), serial cross-sectional analysis (2006 to 2016) was performed. Joinpoint trend analysis evaluated prevalence and mortality with average annual percent change (AAPC). HIV (+) patients and liver diseases (LDs) were identified using International Classification of Diseases 9/10 codes. NAFLD was presumed using diagnosis codes or codes for metabolic dysfunction and obesity in absence of other LDs. Liver-related HIV (+) indicated HIV (+) patients with LDs.
Among 28 675 887 Medicare beneficiaries, 47 062 were HIV (+) (mean [SD] age, 51.4 [11.3] years); 11 920 had liver diseases (6923 HCV, 2019 hepatitis B virus [HBV], 2472 presumed NAFLD, 278 alcoholic liver disease [ALD], and 1653 other LDs); 2882 HIV (+) patients died; 1260 had LDs. The prevalence and mortality for non-liver-related HIV (+) decreased (AAPC, -1.1% and -9.1%). Liver-related HIV (+) increased (AAPC, 1.7%; = .007); mortality leveled off. Prevalence and mortality worsened for presumed NAFLD (AAPC, 9.7% and 10.0%) and improved for HBV and HCV (HBV: AAPC, -3.5% and -8.8%; HCV: AAPC, -0.7% and -4.9%). After adjustments, HCV (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.24-172), HBV (OR, 2.40; 95% CI, 2.09-2.77), ALD (OR, 5.70; 95% CI, 4.34-7.48), and presumed NAFLD (OR, 1.46; 95% CI, 1.24-1.72) increased 1-year mortality.
Among HIV (+) subjects, viral hepatitis remains the leading LD for increased 1-year mortality, but the prevalence and mortality with presumed NAFLD are increasing.
针对艾滋病毒和丙型肝炎病毒（HCV）的新型治疗方法已降低了艾滋病毒/丙型肝炎病毒患者的死亡率。非酒精性脂肪性肝病（NAFLD）在全球范围内呈上升趋势；因此，对艾滋病毒阳性患者中NAFLD的患病率和死亡率进行了评估。
利用医疗保险分母、住院和门诊病历（每年随机抽取5%的样本），进行了系列横断面分析（2006年至2016年）。连接点趋势分析采用平均年变化率（AAPC）评估患病率和死亡率。使用国际疾病分类第9/10版代码识别艾滋病毒阳性患者和肝病（LDs）。在没有其他肝病的情况下，使用诊断代码或代谢功能障碍和肥胖代码推定NAFLD。与肝脏相关的艾滋病毒阳性指患有肝病的艾滋病毒阳性患者。
在28675887名医疗保险受益人中，47062人艾滋病毒呈阳性（平均[标准差]年龄为51.4[11.3]岁）；11920人患有肝病（6923人感染HCV，2019人感染乙型肝炎病毒[HBV]，2472人推定患有NAFLD，278人患有酒精性肝病[ALD]，1653人患有其他肝病）；2882名艾滋病毒阳性患者死亡；1260人患有肝病。与肝脏无关的艾滋病毒阳性患者的患病率和死亡率下降（AAPC分别为-1.1%和-9.1%）。与肝脏相关的艾滋病毒阳性患者人数增加（AAPC为1.7%；P = 0.007）；死亡率趋于平稳。推定的NAFLD的患病率和死亡率恶化（AAPC分别为9.7%和10.0%），而HBV和HCV的患病率和死亡率有所改善（HBV：AAPC分别为-3.5%和-8.8%；HCV：AAPC分别为-0.7%和-4.9%）。调整后，HCV（比值比[OR]为2.00；95%置信区间[CI]为1.24 - 1.72）、HBV（OR为2.40；95% CI为2.09 - 2.77）、ALD（OR为5.70；95% CI为4.34 - 7.48）和推定的NAFLD（OR为1.46；95% CI为1.24 - 1.72）增加了1年死亡率。
在艾滋病毒阳性受试者中，病毒性肝炎仍然是导致1年死亡率增加的主要肝病，但推定的NAFLD的患病率和死亡率正在上升。
