Navarro Jordi, Curran Adrian, Raventós Berta, García Jorge, Suanzes Paula, Descalzo Vicente, Álvarez Patricia, Espinosa Nuria, Montes Marisa Luisa, Suárez-García Inés, Amador Concha, Muga Roberto, Falcó Vicenç, Burgos Joaquín
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain.
Institut de Recerca Vall d'Hebron, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Eur J Intern Med. 2023 Apr;110:54-61. doi: 10.1016/j.ejim.2023.01.028. Epub 2023 Feb 8.
Non-alcoholic fatty liver disease (NAFLD) is one of the most important liver comorbidities in people living with HIV (PLWH). Factors that could lead to a higher prevalence of NAFLD or ease the onset of fibrosis are unclear.
Cohort study of the Spanish HIV Research Network, which comprehends 46 hospitals and more than 15,000 PLWH. Primary objectives were to assess NAFLD prevalence and liver fibrosis according to hepatic steatosis index (HSI) and NAFLD fibrosis score, respectively. Factors associated with both were analysed.
A total of 4798 PLWH were included of whom 1461 (30.5%) showed an HSI>36; these patients had higher risk for significant fibrosis (OR 1.91; 95%CI 1.11-3.28). Factors associated with NAFLD were body mass index (OR 2.05; 95%CI 1.94-2.16) and diabetes (OR 4.68; 95%CI 2.17-10.08), while exposure to integrase strand transfer inhibitors showed a lower risk (OR 0.78; 95%CI 0.62-0.97). In patients with HSI>36, being female (OR 7.33; 95%CI 1.34-40), age (OR 1.22; 95%CI 1.11-1.34), body mass index (OR 1.35; 95%CI 1.18-1.54) and exposure to thymidine analogues (OR 75.4, 95%CI 6.9-823.5) were associated with a higher risk of significant fibrosis. However, exposure to non-nucleoside reverse transcriptase inhibitors (OR 0.12, 95%CI 0.02-0.89) and time of exposure to protease inhibitors (OR 0.97, 95%CI 0.95-1) showed a lower risk.
NAFLD prevalence was high in our cohort. Patients exposed to INSTI showed a lower risk of NAFLD. In patients with hepatic steatosis, exposure to thymidine analogues had 75-fold more risk of significant fibrosis while exposure to NNRTIs reduced this risk.
非酒精性脂肪性肝病（NAFLD）是人类免疫缺陷病毒（HIV）感染者（PLWH）中最重要的肝脏合并症之一。导致NAFLD患病率较高或使纤维化发病更容易的因素尚不清楚。
对西班牙HIV研究网络进行队列研究，该网络包括46家医院和超过15000名PLWH。主要目标分别是根据肝脂肪变性指数（HSI）和NAFLD纤维化评分评估NAFLD患病率和肝纤维化情况。分析与两者相关的因素。
共纳入4798名PLWH，其中1461名（30.5%）的HSI>36；这些患者发生显著纤维化的风险更高（OR 1.91；95%CI 1.11-3.28）。与NAFLD相关的因素有体重指数（OR 2.05；95%CI 1.94-2.16）和糖尿病（OR 4.68；95%CI 2.17-10.08），而暴露于整合酶链转移抑制剂的风险较低（OR 0.78；95%CI 0.62-0.97）。在HSI>36的患者中，女性（OR 7.33；95%CI 1.34-40）、年龄（OR 1.22；95%CI 1.11-1.34）、体重指数（OR 1.35；95%CI 1.18-1.54）和暴露于胸苷类似物（OR 75.4，95%CI 6.9-823.5）与显著纤维化风险较高相关。然而，暴露于非核苷类逆转录酶抑制剂（OR 0.12，95%CI 0.02-0.89）和蛋白酶抑制剂的暴露时间（OR 0.97，95%CI 0.95-1）显示风险较低。
我们队列中的NAFLD患病率较高。暴露于整合酶链转移抑制剂的患者发生NAFLD的风险较低。在肝脂肪变性患者中，暴露于胸苷类似物发生显著纤维化的风险高75倍，而暴露于非核苷类逆转录酶抑制剂可降低这种风险。
