Metabolic Liver Research Program.
I. Department of Medicine, University Medical Centre Mainz, Germany.
AIDS. 2022 Oct 1;36(12):1665-1674. doi: 10.1097/QAD.0000000000003312. Epub 2022 Jul 8.
Metabolic risk factors and nonalcoholic fatty liver disease (NAFLD) in people with HIV (PWH) have been increasing. Patients exhibiting the inflammatory subtype nonalcoholic steatohepatitis (NASH) are at increased risk of liver-related complications. Therefore, the aim was to investigate the prevalence of NASH with significant fibrosis in PWH using noninvasive tests (NITs).
In this prospectively enrolling cohort study, 282 PWH were explored for hepatic steatosis, fibrosis and steatohepatitis using vibration-controlled transient elastography (VCTE) and the Fibroscan-AST (FAST) score.
On the basis of controlled attenuation parameter (CAP; dB/m) and liver stiffness measurement (LSM; kPa), patients were categorized according to the presence of steatosis (≥275 dB/m) and significant fibrosis (≥8.2 kPa). The FAST score was calculated according to established cut-offs.
The prevalence of hepatic steatosis in this cohort was 35.5% ( n = 100) with 75 (75%) of these patients fulfilling the criteria of NAFLD. The prevalence of significant fibrosis (≥ F2) was 6.7% ( n = 19). The FAST score identified a total of 32 (12.3%) patients with a cut-off greater than 0.35, of whom 28 (87.5%) PWH qualified as NASH. On multivariable analysis, waist circumference was a predictor of hepatic steatosis and type 2 diabetes was a predictor of significant fibrosis. Type 2 diabetes and ALT remained independent predictors of a FAST score greater than 0.35.
NASH with significant fibrosis is highly prevalent among PWH. The FAST score may be helpful to identify patients at risk for significant liver disease.
HIV（艾滋病毒）感染者（PWH）的代谢危险因素和非酒精性脂肪性肝病（NAFLD）一直在增加。表现为炎症型非酒精性脂肪性肝炎（NASH）的患者发生与肝脏相关并发症的风险增加。因此，本研究旨在使用非侵入性检测（NITs）调查 PWH 中具有显著纤维化的 NASH 的流行率。
在这项前瞻性入组队列研究中，使用振动控制瞬态弹性成像（VCTE）和 Fibroscan-AST（FAST）评分，对 282 名 PWH 进行肝脂肪变性、纤维化和脂肪性肝炎的研究。
根据受控衰减参数（CAP；dB/m）和肝硬度测量值（LSM；kPa），根据存在脂肪变性（≥275dB/m）和显著纤维化（≥8.2kPa）对患者进行分类。根据既定截断值计算 FAST 评分。
该队列中肝脂肪变性的患病率为 35.5%（n=100），其中 75 例（75%）患者符合 NAFLD 标准。显著纤维化（≥F2）的患病率为 6.7%（n=19）。FAST 评分共识别出 32 例（12.3%）截断值大于 0.35 的患者，其中 28 例（87.5%）PWH 符合 NASH 标准。多变量分析显示，腰围是肝脂肪变性的预测因素，2 型糖尿病是显著纤维化的预测因素。2 型糖尿病和 ALT 仍然是 FAST 评分大于 0.35 的独立预测因素。
PWH 中 NASH 合并显著纤维化的患病率很高。FAST 评分可能有助于识别发生严重肝脏疾病风险较高的患者。
