University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Top Antivir Med. 2022 Oct;30(4):547-558.
Despite substantial advances in the field, liver disease morbidity and mortality remain serious issues among people with HIV. The causes of liver disease are often multifactorial and include hepatitis viruses, hepatic steatosis and oxidative stress, bacterial translocation with activation of hepatic macrophages and stellate cells, and direct toxicities from alcohol and drugs of abuse. Biopsychosocial factors including a high prevalence of psychiatric disorders, food insecurity, insufficient access to care and medications, and social stigma all play roles in the persistence of liver injury and hepatic fibrosis development among people with HIV. Rising rates of hepatocellular carcinoma have been observed, suggesting that the epidemiology of liver disease is evolving.
尽管该领域取得了重大进展，但肝脏疾病的发病率和死亡率仍然是 HIV 感染者面临的严重问题。肝脏疾病的病因通常是多因素的，包括肝炎病毒、肝脂肪变性和氧化应激、细菌易位伴肝巨噬细胞和星状细胞激活，以及酒精和滥用药物的直接毒性。生物心理社会因素，包括精神障碍的高患病率、食物不安全、获得医疗和药物的机会不足，以及社会耻辱感，都在 HIV 感染者肝损伤和肝纤维化发展的持续存在中发挥作用。肝癌的发病率不断上升，表明肝脏疾病的流行病学正在发生变化。
