Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.
Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.
J Acquir Immune Defic Syndr. 2024 Jan 1;95(1):97-106. doi: 10.1097/QAI.0000000000003322.
Because of improved life expectancy in people living with HIV (PLWH), liver disease is increasingly being recognized. We assessed nonviral chronic liver disease burden in PLWH.
The HIV non-virAL liver disease study (2014-2021) prospectively recruited PLWH with elevated serum alanine aminotransferase levels and negative hepatitis serology. Clinically significant hepatic fibrosis (CSHF) was defined as liver stiffness measurement of >7.1 kPa and hazardous alcohol use as Alcohol Use Disorders Identification Test score ≥ 8. Primary outcome was prevalence/predictors of CSHF.
Total recruited were n = 274, 92% male, median age 52 (45-59) years, and 96% having undetectable HIV viral load. Overall, n = 97 (35%) had hazardous alcohol use, n = 72 (26%) had metabolic syndrome, and 17%-27% had exposure to hepatotoxic antiretrovirals. Prevalence of CSHF was 20% (n = 54), prevalence of cirrhosis (liver stiffness measurement > 12.5 kPa) being 7% (19/274). Risk factors for CSHF were hazardous alcohol use in 44% (n = 24), metabolic syndrome in 46% (n = 25), and hepatotoxic antiretrovirals in 56% (n = 30), most having more than one risk factor. Independent predictors of CSHF were serum high-density lipoprotein (odds ratio [OR] 0.220; 95% confidence interval [CI]: 0.061 to 0.790, P = 0.020) (inverse relationship); serum aspartate aminotransferase (OR 1.033, 95% CI: 1.001 to 1.067, P = 0.045), and didanosine use (OR 2.878, 95% CI: 1.228 to 6.774, P = 0.015). Moderate-severe hepatic steatosis was identified in 52% (n = 142). FIB-4 and aspartate aminotransferase-to-platelet ratio index performed poorly in predicting CSHF (positive predictive value 27.3% and 30.6%, respectively) and advanced fibrosis (≥F3) (positive predictive value 17.6% and 5.9%, respectively).
In this study, 20% of PLWH had CSHF associated with high prevalence of hazardous alcohol use/metabolic syndrome/potentially hepatotoxic antiretrovirals. These potentially modifiable risk factors need addressing.
由于感染艾滋病毒（HIV）人群的预期寿命延长，肝脏疾病的发病率逐渐升高。我们评估了 HIV 感染者非病毒性慢性肝脏疾病的负担。
HIV 非病毒性肝脏疾病研究（2014-2021 年）前瞻性地招募了血清丙氨酸氨基转移酶水平升高且肝炎血清学阴性的 HIV 感染者。临床显著肝纤维化（CSHF）定义为肝脏硬度测量值>7.1kPa 和危险饮酒（酒精使用障碍识别测试评分≥8）。主要结局是 CSHF 的患病率/预测因素。
共招募了 274 名患者，92%为男性，中位年龄为 52（45-59）岁，96%的 HIV 病毒载量无法检测。总体而言，97 名（35%）患者有危险饮酒，72 名（26%）患者有代谢综合征，17%-27%的患者有肝毒性抗逆转录病毒药物暴露。CSHF 的患病率为 20%（n=54），肝硬化（肝脏硬度测量值>12.5kPa）的患病率为 7%（19/274）。CSHF 的危险因素包括危险饮酒（n=24，44%）、代谢综合征（n=25，46%）和肝毒性抗逆转录病毒药物（n=30，56%），大多数患者有一个以上的危险因素。CSHF 的独立预测因素是血清高密度脂蛋白（OR 0.220；95%置信区间：0.061 至 0.790，P=0.020）（呈负相关）；血清天冬氨酸氨基转移酶（OR 1.033，95%置信区间：1.001 至 1.067，P=0.045）和地达诺辛的使用（OR 2.878，95%置信区间：1.228 至 6.774，P=0.015）。52%（n=142）的患者有中度至重度肝脂肪变性。FIB-4 和天冬氨酸氨基转移酶/血小板比值指数在预测 CSHF（阳性预测值分别为 27.3%和 30.6%）和晚期纤维化（≥F3）（阳性预测值分别为 17.6%和 5.9%）方面表现不佳。
在这项研究中，20%的 HIV 感染者患有 CSHF，与危险饮酒/代谢综合征/潜在肝毒性抗逆转录病毒药物的高患病率有关。这些潜在的可改变的危险因素需要得到解决。
