Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA.
Clin Infect Dis. 2022 Dec 19;75(12):2119-2127. doi: 10.1093/cid/ciac337.
Whether human immunodeficiency virus (HIV) infection is associated with the development of nonalcoholic steatohepatitis (NASH) remains unclear. The FibroScan-aspartate aminotransferase (FAST) score was developed to identify patients who have histologic NASH with high nonalcoholic fatty liver disease activity score (NAS ≥4) and significant liver fibrosis (≥F2), which has been associated with higher risk of end-stage liver disease. We examined whether HIV infection is associated with elevated FAST score in a large United States (US) cohort.
Vibration-controlled transient elastography was performed in 1309 women without history of chronic viral hepatitis enrolled from 10 US sites: 928 women with HIV (WWH) and 381 women without HIV (WWOH). We used multivariable logistic regression to evaluate associations of HIV, demographic, lifestyle, and metabolic factors with an elevated (>0.35) FAST score.
Median age of WWH and WWOH was 51 years and 48 years, respectively. Most (90%) WWH were on antiretroviral therapy and 72% had undetectable HIV RNA. Prevalence of elevated FAST score was higher among WWH compared to WWOH (6.3% vs 1.8%, respectively; P = .001). On multivariable analysis, HIV infection was associated with 3.7-fold higher odds of elevated FAST score (P = .002), and greater waist circumference (per 10 cm) was associated with 1.7-fold higher odds (P < .001). In analysis limited to WWH, undetectable HIV RNA and current protease inhibitor use were independently associated with lower odds of elevated FAST score.
Our findings suggest that HIV is an independent risk factor for NASH with significant activity and fibrosis. Studies validating FAST score in persons with HIV are warranted.
人类免疫缺陷病毒（HIV）感染是否与非酒精性脂肪性肝炎（NASH）的发展有关尚不清楚。FibroScan-天冬氨酸氨基转移酶（FAST）评分的目的是确定组织学 NASH 患者，这些患者具有较高的非酒精性脂肪性肝病活动评分（NAS≥4）和显著的肝纤维化（≥F2），这与终末期肝病的风险增加有关。我们在一个大型美国（US）队列中研究了 HIV 感染是否与 FAST 评分升高有关。
对来自美国 10 个地点的 1309 名无慢性病毒性肝炎病史的女性进行了振动控制瞬态弹性成像：928 名 HIV 阳性（WHW）女性和 381 名 HIV 阴性（WWOH）女性。我们使用多变量逻辑回归来评估 HIV、人口统计学、生活方式和代谢因素与升高（>0.35）FAST 评分之间的关联。
WHW 和 WWOH 的中位年龄分别为 51 岁和 48 岁。大多数（90%）WHW 正在接受抗逆转录病毒治疗，72%的患者 HIV RNA 无法检测到。与 WWOH 相比，WHW 的 FAST 评分升高的患病率更高（分别为 6.3%和 1.8%；P =.001）。多变量分析表明，HIV 感染与 FAST 评分升高的几率增加 3.7 倍相关（P =.002），腰围每增加 10cm，几率增加 1.7 倍（P<.001）。在仅限于 WHW 的分析中，无法检测到的 HIV RNA 和当前蛋白酶抑制剂的使用与 FAST 评分升高的几率降低独立相关。
我们的研究结果表明，HIV 是非酒精性脂肪性肝炎的一个独立危险因素，具有显著的活性和纤维化。有必要在 HIV 感染者中验证 FAST 评分。
