印度人类免疫缺陷病毒感染患者的非酒精性脂肪性肝病患病率高，但病情较轻。

Indian patients with human immunodeficiency virus infection have high prevalence but mild severity of non-alcoholic fatty liver disease.

机构信息

Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

Diabetes Metab Syndr. 2022 Dec;16(12):102679. doi: 10.1016/j.dsx.2022.102679. Epub 2022 Nov 23.

DOI:10.1016/j.dsx.2022.102679

PMID:36450180

Abstract

BACKGROUND AND AIMS

Antiretroviral therapy (ART) has substantially decreased AIDS-related mortality. Non-AIDS related diseases like chronic liver disease are becoming more frequent in people living with HIV-AIDS (PLHA). Non-alcoholic fatty live disease (NAFLD) is a common etiology of liver disease in the general population. Our aim was to analyse the prevalence and risk factors of NAFLD in Indian PLHA.

METHODS

One hundred consecutive adults (age:36.89 ± 10.4 years, males:65%) with HIV infection were prospectively enrolled. Patients with significant alcohol intake, Hepatitis B or Cco-infection, other liver disease, malignancy or HIV stage IV were excluded. Hepatic steatosis was assessed using hepatobiliary ultrasoundand controlled attenuation parameter (CAP). Fibrosis was assessed non-invasively using FIB-4, NAFLD fibrosis score (NFS) and liver stiffness measurement (LSM). Metabolic and HIV-related risk factors were compared between PLHA with and without NAFLD.

RESULTS

Prevalence of NAFLD using CAP was 60%. Among patients with NAFLD, 27 (45%) were lean. Majority had mild-moderate steatosis. Advanced fibrosis was present in 1 (1.67%) and 4 (6.67%) patients using NFS and LSM and none using FIB-4. PLHA with NAFLD were more likely to be overweight or obese (OR = 4.21,p = 0.002) with a higher proportion of abdominal obesity (OR:25.26,p = 0.001). Other metabolic comorbidities, duration of HIV infection, duration and type of ART, CD4-count or HIV-stagewere not significantly different among PLHA with or without NAFLD.

CONCLUSION

Prevalence of NAFLD among Indian PLHA is high although most have mild disease. Almost half of these patients are lean. HIV-related factors do not impact the risk of NAFLD.

摘要

背景与目的

抗逆转录病毒疗法（ART）大大降低了艾滋病相关死亡率。在艾滋病毒感染者（PLHA）中，非艾滋病相关疾病（如慢性肝病）变得越来越常见。非酒精性脂肪性肝病（NAFLD）是普通人群中肝病的常见病因。我们的目的是分析印度 PLHA 中 NAFLD 的患病率和危险因素。

方法

前瞻性纳入 100 名连续成年（年龄：36.89±10.4 岁，男性：65%）HIV 感染者。排除大量饮酒、乙型肝炎或丙型肝炎合并感染、其他肝病、恶性肿瘤或 HIV 期 4 者。使用肝胆超声和受控衰减参数（CAP）评估肝脂肪变性。使用 FIB-4、NAFLD 纤维化评分（NFS）和肝硬度测量（LSM）无创性评估纤维化。比较有和无 NAFLD 的 PLHA 之间的代谢和 HIV 相关危险因素。

结果

使用 CAP 诊断的 NAFLD 患病率为 60%。在有 NAFLD 的患者中，27 例（45%）为瘦型。大多数患者有轻中度脂肪变性。使用 NFS 和 LSM 有 1 例（1.67%）和 4 例（6.67%）患者存在晚期纤维化，而使用 FIB-4 则无。有 NAFLD 的 PLHA 更有可能超重或肥胖（OR=4.21，p=0.002），且存在更多的腹部肥胖（OR：25.26，p=0.001）。PLHA 中代谢合并症、HIV 感染持续时间、ART 持续时间和类型、CD4 计数或 HIV 期在有和无 NAFLD 者之间无显著差异。