Division of Infectious Diseases, UTHealth Houston, Houston, TX.
Department of Endocrinology, Johns Hopkins University, Baltimore, MD.
J Acquir Immune Defic Syndr. 2024 Oct 1;97(2):165-171. doi: 10.1097/QAI.0000000000003477.
Frailty is associated with obesity-related comorbidities, but the relationship with nonalcoholic fatty liver disease (NAFLD) in people with HIV has been incompletely described. Our objective was to assess the associations between NAFLD and frailty.
Cross-sectional and longitudinal analysis of men in the Multicenter AIDS Cohort Study. NAFLD was defined as a liver/spleen ratio <1.0 on abdominal computed tomography scans; frailty was defined by the frailty phenotype as having 3 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity.
Men without (n = 200) and with HIV (n = 292) were included. NAFLD prevalence was 21% vs 16% and frailty 12% vs 17%, respectively. Among men with NAFLD, frailty was more prevalent in men without HIV (21% vs 11%). In multivariate analysis, NAFLD was significantly associated with frailty after controlling for significant variables. Men without HIV and NAFLD had 2.6 times higher probability [95% confidence interval (CI): 1.2- to 5.7] of frailty relative to men with neither HIV nor NAFLD. This association was not seen in men with HIV. The probability of frailty was higher among men without HIV with NAFLD (27% vs 10% in men without NAFLD) but lower among men with HIV with NAFLD (14% vs 19% in men without NAFLD). No significant relationships were found in longitudinal analyses.
NAFLD was independently associated with frailty among men without HIV but not men with HIV, despite increased prevalence of frailty among men with HIV. The mechanisms of the muscle-liver-adipose tissue axis underlying NAFLD might differ by HIV serostatus.
衰弱与肥胖相关的合并症有关，但在 HIV 感染者中与非酒精性脂肪性肝病（NAFLD）的关系尚未完全描述。我们的目的是评估 NAFLD 与衰弱之间的关系。
对多中心艾滋病队列研究中的男性进行横断面和纵向分析。NAFLD 的定义为腹部计算机断层扫描（CT）扫描肝脏/脾脏比值<1.0；衰弱通过衰弱表型定义为以下 3 种情况：虚弱、缓慢、体重减轻、疲惫和低体力活动。
共纳入无 HIV（n=200）和 HIV 感染（n=292）的男性。NAFLD 的患病率分别为 21%和 16%，衰弱的患病率分别为 12%和 17%。在患有 NAFLD 的男性中，无 HIV 的男性中衰弱更为常见（21% vs 11%）。在多变量分析中，在控制了重要变量后，NAFLD 与衰弱显著相关。无 HIV 且无 NAFLD 的男性发生衰弱的可能性是既无 HIV 也无 NAFLD 的男性的 2.6 倍[95%置信区间（CI）：1.2-至 5.7]。在 HIV 感染的男性中未观察到这种关联。无 HIV 且有 NAFLD 的男性衰弱的可能性更高（27% vs 无 NAFLD 的男性 10%），而有 HIV 且有 NAFLD 的男性衰弱的可能性更低（14% vs 无 NAFLD 的男性 19%）。在纵向分析中未发现显著相关性。
尽管 HIV 感染的男性中衰弱更为常见，但无 HIV 感染的男性中，NAFLD 与衰弱独立相关，而 HIV 感染的男性中则不然。NAFLD 所涉及的肌肉-肝脏-脂肪组织轴的机制可能因 HIV 血清状态而异。
