Huang Huihuang, Song Bing, Gao Lin, Cheng Juan, Mao Yufeng, Zhao Hua, Tu Bo, Huang Shun, Zhang Jieli, Chen Dianjie, Zhao Peng, Jiao Yan-Mei, Jiang Tianjun
Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Microbiology & Infectious Disease Center, School of Basic Medical Science, Peking University Health Science Center, Beijing, China.
HIV Med. 2022 Mar;23 Suppl 1:14-22. doi: 10.1111/hiv.13245.
The study aimed to investigate the incidence of and risk factors for liver damage in patients with human immunodeficiency virus type-1 (HIV-1) mono-infection receiving antiretroviral therapy (ART).
We retrospectively analyzed the clinical data of patients who were diagnosed with HIV-1 infection and initiated ART from January to December 2017. Among them, 382 patients with HIV-1 mono-infection and normal baseline liver function were included in the analysis. The incidence of liver damage at each follow-up point, and possible risk factors for liver damage were evaluated via COX regression survival analyses.
The overall incidence of liver damage (grade I-IV) was 27.23% (interquartile range [IQR]: 26.38%-28.72%). Grade I liver damage was most common and accounted for 22.13% of cases (IQR: 21.06%-24.04%), while grade II liver damage accounted for 3.40% of cases (IQR: 3.19%-4.26%). COX regression and survival analyses revealed that baseline body mass index (BMI), alanine aminotransferase (ALT) level, CD4 T cell count, HIV-1 viral load, and the antiretroviral regimen were significantly correlated with the occurrence of liver damage. Moreover, baseline ALT levels and HIV-1 viral load were identified as independent risk factors for liver damage in patients with HIV-1 mono-infection.
Liver damage is common in patients with HIV-1 mono-infection undergoing ART. Patients with risk factors for liver damage should be well-informed before the initiation of ART, and liver function should be closely monitored during ART even in patients with normal liver function before ART.
本研究旨在调查接受抗逆转录病毒治疗（ART）的1型人类免疫缺陷病毒（HIV-1）单感染患者肝损伤的发生率及危险因素。
我们回顾性分析了2017年1月至12月被诊断为HIV-1感染并开始接受ART治疗的患者的临床资料。其中，382例HIV-1单感染且基线肝功能正常的患者被纳入分析。通过COX回归生存分析评估各随访点肝损伤的发生率以及肝损伤的可能危险因素。
肝损伤（I-IV级）的总体发生率为27.23%（四分位间距[IQR]：26.38%-28.72%）。I级肝损伤最为常见，占病例的22.13%（IQR：21.06%-24.04%），而II级肝损伤占病例的3.40%（IQR：3.19%-4.26%）。COX回归和生存分析显示基线体重指数（BMI）、丙氨酸氨基转移酶（ALT）水平、CD4 T细胞计数、HIV-1病毒载量以及抗逆转录病毒治疗方案与肝损伤的发生显著相关。此外，基线ALT水平和HIV-1病毒载量被确定为HIV-1单感染患者肝损伤的独立危险因素。
接受ART治疗的HIV-1单感染患者肝损伤很常见。在开始ART治疗前，应充分告知有肝损伤危险因素的患者相关情况，并且在ART治疗期间，即使是ART治疗前肝功能正常的患者也应密切监测肝功能。
