Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.
Infectious Diseases Unit, Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.
Clin Infect Dis. 2020 Dec 17;71(10):e694-e701. doi: 10.1093/cid/ciaa430.
The burden of nonalcoholic fatty liver disease (NAFLD) is growing in people living with human immunodeficiency virus (HIV). NAFLD is associated with obesity; however, it can occur in normoweight (lean) patients. We aimed to investigate lean NAFLD in patients living with HIV.
We included patients living with HIV mono-infection from 3 prospective cohorts. NAFLD was diagnosed by transient elastography (TE) and defined as controlled attenuation parameter ≥248 dB/m, in absence of alcohol abuse. Lean NAFLD was defined when a body mass index was <25 kg/m2. Significant liver fibrosis was defined as TE ≥7.1 kPa. The presence of diabetes, hypertension, or hyperlipidemia defined metabolically abnormal patients.
We included 1511 patients, of whom 57.4% were lean. The prevalence of lean NAFLD patients in the whole cohort was 13.9%. NAFLD affected 24.2% of lean patients. The proportions of lean NAFLD patients who were metabolically abnormal or had elevated alanine aminotransferase (ALT) were higher than among those who were lean patients without NAFLD (61.9% vs 48.9% and 36.7% vs 24.2%, respectively). Lean NAFLD patients had a higher prevalence of significant liver fibrosis than lean patients without NAFLD (15.7% vs 7.6%, respectively). After adjusting for sex, ethnicity, hypertension, CD4 cell count, nadir CD4 <200µ/L, and time since HIV diagnosis, predictors of NAFLD in lean patients were age (adjusted OR [aOR], 1.29; 95% confidence interval [CI], 1.04-1.59), high triglycerides (aOR, 1.34; 95% CI, 1.11-1.63), and high ALT (aOR, 1.15; 95% CI, 1.05-1.26), while a high level of high-density lipoprotein cholesterol was protective (aOR, 0.45; 95% CI, .26-.77).
NAFLD affects 1 in 4 lean patients living with HIV mono-infection. Investigations for NAFLD should be proposed in older patients with dyslipidemia and elevated ALT, even if normoweight.
非酒精性脂肪性肝病（NAFLD）在感染人类免疫缺陷病毒（HIV）的人群中的负担正在增加。NAFLD与肥胖有关；然而，它也可能发生在体重正常（瘦）的患者中。我们旨在研究感染 HIV 的瘦型 NAFLD 患者。
我们纳入了来自 3 个前瞻性队列的感染 HIV 的单感染患者。NAFLD 通过瞬时弹性成像（TE）诊断，并定义为控制衰减参数≥248 dB/m，无酒精滥用。当体重指数<25 kg/m2 时，定义为瘦型 NAFLD。TE≥7.1 kPa 定义为显著肝纤维化。糖尿病、高血压或高脂血症定义为代谢异常患者。
我们共纳入了 1511 名患者，其中 57.4%为瘦型。整个队列中瘦型 NAFLD 患者的患病率为 13.9%。NAFLD 影响了 24.2%的瘦型患者。与非 NAFLD 的瘦型患者相比，代谢异常或丙氨酸氨基转移酶（ALT）升高的瘦型 NAFLD 患者比例更高（分别为 61.9%和 36.7%）。与非 NAFLD 的瘦型患者相比，瘦型 NAFLD 患者的显著肝纤维化患病率更高（分别为 15.7%和 7.6%）。在调整了性别、种族、高血压、CD4 细胞计数、最低 CD4<200µ/L 和 HIV 诊断后时间后，瘦型患者中 NAFLD 的预测因素为年龄（调整后的比值比[aOR]，1.29；95%置信区间[CI]，1.04-1.59）、高甘油三酯（aOR，1.34；95%CI，1.11-1.63）和高 ALT（aOR，1.15；95%CI，1.05-1.26），而高密度脂蛋白胆固醇水平升高具有保护作用（aOR，0.45；95%CI，.26-.77）。
感染 HIV 的单感染瘦型患者中有 1/4 患有 NAFLD。即使体重正常，也应建议对血脂异常和 ALT 升高的老年患者进行 NAFLD 检查。
