维也纳 HIV 感染者中从首次就诊到最后随访时非酒精性脂肪性肝病相关纤维化的流行率和动态变化。
Prevalence and dynamics of NAFLD-associated fibrosis in people living with HIV in Vienna from first presentation to last follow-up.
机构信息
Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Red Tower, Gastro-Office 7i, 1090, Vienna, Austria.
Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.
出版信息
Wien Klin Wochenschr. 2023 Aug;135(15-16):420-428. doi: 10.1007/s00508-022-02133-9. Epub 2022 Dec 28.
BACKGROUND/AIMS: Non-alcoholic fatty liver disease (NAFLD) is frequent in people living with HIV (PLWH) and may be aggravated by metabolic comorbidities and antiretroviral therapy (ART)-associated adverse effects.
METHODS
We retrospectively assessed epidemiological, clinical and laboratory parameters and ART regimens at HIV diagnosis (BL) and at last follow-up (FU) in 1458 PLWH without viral hepatitis coinfection attending our HIV clinic in 2014-2016. Fibrosis was non-invasively assessed by the NAFLD fibrosis score (NFS).
RESULTS
The median age of subjects was 37.8 years, 77.4% were male and 67.2% on ART, median CD4+ count was 356.0 cells/µL. At BL, 503 (34.5%) and 20 (1.4%) PLWH had dyslipidemia and diabetes, respectively. According to the NFS 16 (1.3%) showed advanced fibrosis (NFS ≥ 0.676), among which 1 (6.3%) had diabetes, 7 (43.8%) had dyslipidemia, and 5 (31.3%) were on HIV-protease inhibitors (PI). In addition, 191(15.1%) had intermediate NFS results, while fibrosis was ruled out (NFS ≤ 1.455) in 1065 (83.7%) PLWH. After a median follow-up of 6.3 years, 590 (42.8%) had dyslipidemia and 61 (4.4%) had diabetes. Also, 21 (1.6%) showed advanced fibrosis, of which 10 (47.6%) had diabetes, 4 (19.0%) had dyslipidemia, and 9 (42.9%) were on PI-based ART, 223 (17.4%) had intermediate NFS results, while 1039 (81.0%) showed no fibrosis.
CONCLUSION
During FU, advanced NAFLD fibrosis occurred in 1.3-1.6% of PLWH. Dyslipidemia, diabetes, and PI-based ART were associated with advanced NAFLD fibrosis. Prospective investigations of NAFLD severity and risk factors in PLWH are warranted.
背景/目的：非酒精性脂肪性肝病（NAFLD）在感染人类免疫缺陷病毒（HIV）的人群中很常见，并且可能会因代谢合并症和抗逆转录病毒治疗（ART）相关的不良反应而加重。
方法
我们回顾性评估了 2014-2016 年间在我们的 HIV 诊所就诊、无病毒性肝炎合并感染的 1458 例 HIV 感染者在 HIV 诊断（BL）和末次随访（FU）时的流行病学、临床和实验室参数以及 ART 方案。NAFLD 纤维化评分（NFS）用于非侵入性评估纤维化。
结果
受试者的中位年龄为 37.8 岁，77.4%为男性，67.2%正在接受 ART 治疗，中位 CD4+细胞计数为 356.0 个/µL。在 BL 时，503（34.5%）和 20（1.4%）例 HIV 感染者分别存在血脂异常和糖尿病。根据 NFS，16（1.3%）例显示晚期纤维化（NFS≥0.676），其中 1（6.3%）例有糖尿病，7（43.8%）例有血脂异常，5（31.3%）例正在接受 HIV 蛋白酶抑制剂（PI）治疗。此外，191（15.1%）例有中等程度的 NFS 结果，而 1065（83.7%）例 HIV 感染者的纤维化则排除在外（NFS≤1.455）。在中位随访 6.3 年后，590（42.8%）例出现血脂异常，61（4.4%）例出现糖尿病。另外，21（1.6%）例显示晚期纤维化，其中 10（47.6%）例有糖尿病，4（19.0%）例有血脂异常，9（42.9%）例正在接受基于 PI 的 ART 治疗，223（17.4%）例有中等程度的 NFS 结果，而 1039（81.0%）例无纤维化。
结论
在 FU 期间，1.3%-1.6%的 HIV 感染者出现进展性 NAFLD 纤维化。血脂异常、糖尿病和基于 PI 的 ART 与进展性 NAFLD 纤维化相关。有必要对 HIV 感染者的 NAFLD 严重程度和危险因素进行前瞻性研究。
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