Amponsah-Dacosta Edina, Tamandjou Tchuem Cynthia, Anderson Motswedi
Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa.
Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa.
World J Virol. 2020 Dec 15;9(5):54-66. doi: 10.5501/wjv.v9.i5.54.
Globally, a shift in the epidemiology of chronic liver disease has been observed. This has been mainly driven by a marked decline in the prevalence of chronic hepatitis B virus infection (CHB), with the greatest burden restricted to the Western Pacific and sub-Saharan African regions. Amidst this is a growing burden of metabolic syndrome (MetS) worldwide. A disproportionate co-burden of human immunodeficiency virus (HIV) infection is also reported in sub-Saharan Africa, which poses a further risk of liver-related morbidity and mortality in the region. We reviewed the existing evidence base to improve current understanding of the effect of underlying MetS on the development and progression of chronic liver disease during CHB and HIV co-infection. While the mechanistic association between CHB and MetS remains poorly resolved, the evidence suggests that MetS may have an additive effect on the liver damage caused by CHB. Among HIV infected individuals, MetS-associated liver disease is emerging as an important cause of non-AIDS related morbidity and mortality despite antiretroviral therapy (ART). It is plausible that underlying MetS may lead to adverse outcomes among those with concomitant CHB and HIV co-infection. However, this remains to be explored through rigorous longitudinal studies, especially in sub-Saharan Africa. Ultimately, there is a need for a comprehensive package of care that integrates ART programs with routine screening for MetS and promotion of lifestyle modification to ensure an improved quality of life among CHB and HIV co-infected individuals.
在全球范围内，已观察到慢性肝病流行病学的转变。这主要是由慢性乙型肝炎病毒感染（CHB）患病率的显著下降所驱动，其最大负担集中在西太平洋和撒哈拉以南非洲地区。与此同时，全球代谢综合征（MetS）的负担正在增加。在撒哈拉以南非洲地区，还报告了不成比例的人类免疫缺陷病毒（HIV）感染共同负担，这给该地区带来了肝脏相关发病和死亡的进一步风险。我们回顾了现有证据基础，以增进对潜在MetS在CHB和HIV合并感染期间对慢性肝病发展和进展影响的当前理解。虽然CHB与MetS之间的机制关联仍未得到很好的解决，但证据表明MetS可能对CHB所致的肝损伤具有累加效应。在HIV感染者中，尽管接受了抗逆转录病毒治疗（ART），但MetS相关肝病正成为非艾滋病相关发病和死亡的重要原因。潜在的MetS可能导致CHB和HIV合并感染者出现不良后果，这似乎是合理的。然而，这仍有待通过严格的纵向研究来探索，尤其是在撒哈拉以南非洲地区。最终，需要一套综合的护理方案，将ART项目与MetS的常规筛查以及促进生活方式改变相结合，以确保CHB和HIV合并感染者的生活质量得到改善。
