Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, West Virginia.
Department of Gastroenterology, Hepatology and Nutrition.
AIDS. 2023 Jul 1;37(8):1209-1216. doi: 10.1097/QAD.0000000000003537. Epub 2023 Mar 3.
To examine and compare the risk of major adverse cardiovascular events (MACEs) between people with HIV (PWH) with and without nonalcoholic fatty liver disease (NAFLD).
Population-based, multicenter, retrospective cohort study.
Data on PWH between January 1, 2008, and December 31, 2020 were extracted from the TriNetX database. Primary outcomes were defined as the first incidence of myocardial infarction (MI), MACE, new-onset heart failure (HF), and a composite of cerebrovascular disease. Cox models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs).
A total of 151 868 patients were identified as having HIV. After exclusions, 4969 patients were identified as having NAFLD. Of them, 4463 (90%) were propensity matched to a non-NAFLD control. Patients with NAFLD were older (42.9 versus 40.8 years). Among the NAFLD cohort, most participants were male and had a smoking history (12.3 versus 9.8%) than non-NAFLD. The mean follow-up was 4.8 ± 1.1 years for the NAFLD group and 5.3 ± 1.2 years for the non-NAFLD group. The risk of all outcomes was statistically significantly higher in NAFLD patients compared to those without NAFLD: MI (HR, 1.49; 95% CI, 1.11-2.01) MACE (HR, 1.49; 95% CI, 1.25-1.79), HF (HR, 1.73; 95% CI 1.37-2.19) and, cerebrovascular diseases (HR, 1.25; 95% CI, 1.05-1.48) and sensitivity analysis showed similar magnitude to the one generated in the primary analysis.
Patients with NAFLD have an elevated risk of adverse cardiovascular events (CVEs). The results indicate the need for targeted efforts to improve awareness of risks factors associated with adverse CVEs risk in PWH with NAFLD.
研究并比较合并与不合并非酒精性脂肪性肝病（NAFLD）的 HIV 感染者（PWH）发生主要不良心血管事件（MACE）的风险。
基于人群的、多中心、回顾性队列研究。
从 TriNetX 数据库中提取 2008 年 1 月 1 日至 2020 年 12 月 31 日期间的 PWH 数据。主要结局定义为首次发生心肌梗死（MI）、MACE、新发心力衰竭（HF）以及脑血管疾病的复合结局。采用 Cox 模型获得风险比（HR）和 95%置信区间（CI）。
共纳入 151868 例 HIV 感染者，排除后，有 4969 例患者被诊断为 NAFLD，其中 4463 例（90%）按倾向评分匹配了非 NAFLD 对照组。NAFLD 组患者年龄较大（42.9 岁比 40.8 岁）。在 NAFLD 队列中，与非 NAFLD 组相比，大多数患者为男性且有吸烟史（12.3%比 9.8%）。NAFLD 组的平均随访时间为 4.8±1.1 年，非 NAFLD 组为 5.3±1.2 年。与非 NAFLD 患者相比，NAFLD 患者发生所有结局的风险均显著更高：MI（HR，1.49；95%CI，1.11-2.01）、MACE（HR，1.49；95%CI，1.25-1.79）、HF（HR，1.73；95%CI，1.37-2.19）和脑血管疾病（HR，1.25；95%CI，1.05-1.48）。敏感性分析得出的结果与主要分析相似。
合并 NAFLD 的 PWH 发生不良心血管事件（CVE）的风险增加。结果表明，需要有针对性地努力提高对 PWH 合并 NAFLD 相关不良 CVE 风险因素的认识。
