与普通人群对照相比，感染人类免疫缺陷病毒但无病毒性肝炎的人群中肝纤维化的发病率更高。

Increased Prevalence of Liver Fibrosis in People Living With Human Immunodeficiency Virus Without Viral Hepatitis Compared to Population Controls.

机构信息

Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.

Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.

出版信息

J Infect Dis. 2021 Aug 2;224(3):443-452. doi: 10.1093/infdis/jiaa763.

DOI:10.1093/infdis/jiaa763

PMID:33320268

Abstract

BACKGROUND

Liver fibrosis is associated with poor liver-related outcomes and mortality. People with human immunodeficiency virus (PWH) may be at increased risk. We aimed to estimate the prevalence and factors associated with liver fibrosis in PWH compared to population controls.

METHODS

This was a cross-sectional cohort study comparing 342 PWH with 2190 population controls aged 50-70 years.Transient elastography was performed and elevated liver stiffness measurement (LSM) defined as 7.6 kPa as a proxy for significant liver fibrosis. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were computed by logistic regression.

RESULTS

The prevalence of elevated LSM was higher in PWH than in uninfected controls (12% vs 7%; P < .01). Human immunodeficiency virus (HIV) infection was independently associated with elevated LSM. In multivariate analysis, elevated LSM was associated with HIV (aOR, 1.84 [95% CI, 1.17-2.88]; P < .01); higher age (per decade: aOR, 3.34 [95% CI, 1.81-6.18]; P < .01); alanine aminotransferase (ALT) (per 10 IU/L: aOR, 1.25 [95% CI, 1.05-1.49]; P < .01); body mass index (BMI) (per 1 kg/m2: aOR, 1.17 [95% CI, 1.05-1.29]; P < .01), and previous exposure to didanosine (per year: aOR, 2.26 [95% CI, 1.01-5.06]; P = .04).

CONCLUSIONS

The prevalence of elevated LSM was higher in PWH compared to population controls. Higher age, BMI, ALT, previous exposure to didanosine, and positive HIV status were independently associated with higher odds of elevated LSM.

摘要

背景

肝纤维化与肝相关不良结局和死亡率升高相关。人类免疫缺陷病毒（HIV）感染者（PWH）可能面临更高的风险。本研究旨在评估与普通人群对照相比，PWH 发生肝纤维化的患病率和相关因素。

方法

这是一项横断面队列研究，比较了 342 名 PWH 和 2190 名年龄在 50-70 岁的普通人群对照。进行瞬时弹性成像检查，以 7.6kPa 作为显著肝纤维化的替代指标来定义升高的肝硬度测量值（LSM）。通过 logistic 回归计算调整后的优势比（aOR）和 95%置信区间（95%CI）。

结果

与未感染对照相比，PWH 中升高的 LSM 患病率更高（12%比 7%；P<0.01）。HIV 感染与升高的 LSM 独立相关。多变量分析显示，升高的 LSM 与 HIV（aOR，1.84[95%CI，1.17-2.88]；P<0.01）、年龄每增加十年（aOR，3.34[95%CI，1.81-6.18]；P<0.01）、丙氨酸氨基转移酶（ALT）（每增加 10IU/L：aOR，1.25[95%CI，1.05-1.49]；P<0.01）、体质指数（BMI）（每增加 1kg/m2：aOR，1.17[95%CI，1.05-1.29]；P<0.01）和既往暴露于去羟肌苷（每年：aOR，2.26[95%CI，1.01-5.06]；P=0.04）相关。