Department of Metabolism, Digestion, and Reproduction, Section of Hepatology, St Mary's Hospital, Imperial College London, London, United Kingdom.
Department of Hepatology, Royal Free Hospital NHS Trust, London, United Kingdom.
Clin Infect Dis. 2021 Oct 5;73(7):e2184-e2193. doi: 10.1093/cid/ciaa1302.
Liver disease is an important cause of morbidity and mortality in people living with human immunodeficiency virus (PLWH), of which nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized cause. There are limited data investigating NAFLD in HIV monoinfection and histologically defined disease. We aimed to identify who is at risk of fibrosis, NAFLD, and nonalcoholic steatohepatitis (NASH) among PLWH and explore the diagnostic accuracy of noninvasive markers of fibrosis.
This was a retrospective, cross-sectional, international, multicenter study including patients with HIV monoinfection, without chronic viral hepatitis or other known causes of chronic liver disease, who underwent liver biopsy for abnormal liver biochemistry and/or clinical suspicion of liver fibrosis.
A total of 116 patients from 5 centers were included. Sixty-three (54%) had NAFLD, of whom 57 (92%) had NASH. Overall, 36 (31%) had advanced fibrosis (≥F3) and 3 (3%) had cirrhosis. Of the 53 cases without NAFLD, 15 (28%) had advanced fibrosis. Collagen proportionate area was similar between cases with and without NAFLD (3% vs 2%). Body mass index was independently associated with NAFLD (aOR, 1.2; 95% CI, 1.08-1.34), and type 2 diabetes was independently associated with advanced fibrosis (aOR, 3.42; 95% CI, 1.00-11.71). The area under the curve for advanced fibrosis was 0.65 and 0.66 for both NAFLD Fibrosis Score (NFS) and FIB-4. Cutoff values of -1.455 (NFS) and 1.3 (FIB-4) have negative-predictive values of 0.80 and 0.82, respectively.
Advanced fibrosis is strongly associated with type 2 diabetes in PLWH. Serological markers require further optimization.
肝脏疾病是人类免疫缺陷病毒（PLWH）患者发病率和死亡率的重要原因，其中非酒精性脂肪性肝病（NAFLD）是一种越来越被认可的原因。关于 HIV 单一感染和组织学定义的疾病中 NAFLD 的数据有限。我们旨在确定 PLWH 中哪些人有发生纤维化、NAFLD 和非酒精性脂肪性肝炎（NASH）的风险，并探讨纤维化非侵入性标志物的诊断准确性。
这是一项回顾性、横断面、国际性、多中心研究，纳入了无慢性病毒性肝炎或其他已知慢性肝病的 HIV 单一感染患者，这些患者因肝功能异常和/或临床怀疑肝纤维化而行肝活检。
共纳入 5 个中心的 116 名患者。63 名（54%）患有 NAFLD，其中 57 名（92%）患有 NASH。总体而言，36 名（31%）患有晚期纤维化（≥F3），3 名（3%）患有肝硬化。在 53 名无 NAFLD 的患者中，有 15 名（28%）患有晚期纤维化。有和无 NAFLD 的患者胶原比例区（CPA）相似（3%对 2%）。体重指数与 NAFLD 独立相关（优势比，1.2；95%可信区间，1.08-1.34），2 型糖尿病与晚期纤维化独立相关（优势比，3.42；95%可信区间，1.00-11.71）。晚期纤维化的曲线下面积（AUC）分别为 NAFLD 纤维化评分（NFS）和 FIB-4 的 0.65 和 0.66。-1.455（NFS）和 1.3（FIB-4）的截断值具有 0.80 和 0.82 的阴性预测值。
在 PLWH 中，晚期纤维化与 2 型糖尿病密切相关。血清标志物需要进一步优化。
