Department of Medicine.
Department of Veteran Affairs Medical Center, San Francisco, CA, USA.
AIDS. 2022 Dec 1;36(15):2147-2152. doi: 10.1097/QAD.0000000000003351. Epub 2022 Aug 10.
Hepatic steatosis is a leading cause of cirrhosis and hepatocellular carcinoma and is highly prevalent in persons with HIV (PWH). However, most studies of hepatic steatosis diagnosis in PWH have focused on those at high risk. We determined the accuracy of vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP) in detecting mild or greater hepatic steatosis as compared with the noninvasive gold standard magnetic resonance spectroscopy (MRS) in PWH.
Among 149 participants with and without HIV, we evaluated test characteristics of CAP and calculated serum indices Hepatic Steatosis Index (HSI) and STEATO-ELSA in identifying 3T MRS-measured hepatic steatosis (defined as a liver fat fraction ≥5%).
Most participants were women and over half were African American. Median BMI was 27 kg/m 2 . Hepatic steatosis prevalence by MRS and CAP (cutoff 248 dB/m) was 36% and 47%, respectively. CAP had an AUROC of 0.82, and the at least 248 dB/m cutoff yielded a sensitivity, specificity, positive-predictive value, and negative-predictive value of 83%, 72%, 61%, and 88%, respectively. These test characteristics were not statistically different from the optimal cutoff of at least 252 dB/m. Higher waist circumference, greater visceral adipose tissue, heavy alcohol use, and VCTE scans flagged as having the probe positioned too low were associated with CAP and MRS discordance. Serum indices of hepatic steatosis had slightly worse performance characteristics than CAP.
CAP may be an effective alternative to MRS for noninvasive hepatic steatosis assessment in PWH. The commonly used CAP cutoff of at least 248 dB/m to diagnose hepatic steatosis can be used in PWH.
肝脂肪变性是肝硬化和肝细胞癌的主要原因，在 HIV 感染者（PWH）中患病率很高。然而，大多数关于 PWH 肝脂肪变性诊断的研究都集中在高危人群上。我们旨在确定受控衰减参数（CAP）振动控制瞬时弹性成像（VCTE）与非侵入性金标准磁共振光谱（MRS）相比，在检测 PWH 中轻度或更严重肝脂肪变性方面的准确性。
在 149 名有和无 HIV 的参与者中，我们评估了 CAP 的检测特征，并计算了肝脂肪指数（HSI）和 STEATO-ELSA 血清指数，以识别 3T MRS 测量的肝脂肪变性（定义为肝脏脂肪分数≥5%）。
大多数参与者为女性，超过一半为非裔美国人。中位 BMI 为 27kg/m 2 。MRS 和 CAP（截断值 248dB/m）检测的肝脂肪变性患病率分别为 36%和 47%。CAP 的 AUROC 为 0.82，至少 248dB/m 的截断值的灵敏度、特异性、阳性预测值和阴性预测值分别为 83%、72%、61%和 88%。这些检测特征与至少 252dB/m 的最佳截断值没有统计学差异。更高的腰围、更大的内脏脂肪组织、大量饮酒和 VCTE 扫描显示探头位置过低与 CAP 和 MRS 不一致有关。肝脂肪变性的血清指数的性能特征略逊于 CAP。
CAP 可能是 PWH 非侵入性肝脂肪变性评估的有效替代方法。用于诊断肝脂肪变性的常用 CAP 截断值至少 248dB/m 可用于 PWH。
