Kuniholm Mark H, Murenzi Gad, Shumbusho Fabienne, Brazier Ellen, Plaisy Marie K, Mensah Ephrem, Wandeler Gilles, Riebensahm Carlotta, Chihota Belinda V, Samala Niharika, Diero Lameck, Semeere Aggrey S, Chanyachukul Thida, Borse Rohidas, Nguyen Dung T H, Perazzo Hugo, Lopez-Iniguez Alvaro, Castilho Jessica L, Maruri Fernanda, Jaquet Antoine
Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA.
Research for Development (RD Rwanda).
AIDS. 2025 Jan 1;39(1):11-21. doi: 10.1097/QAD.0000000000004012. Epub 2024 Sep 11.
The aim of this study was to understand the relationship between cardiovascular disease (CVD) risk and liver steatosis and fibrosis among people with HIV (PLWH) at least 40 years of age on antiretroviral therapy (ART) in low and middle-income countries (LMIC).
We used cross-sectional behavioral and clinical data collected during study enrollment visits in 2020-2022 for the Sentinel Research Network of International epidemiology Databases to Evaluate AIDS (SRN of IeDEA).
Ten-year CVD risk was calculated using 2019 WHO nonlaboratory and laboratory models. Transient elastography was used to assess liver disease. Presence of steatosis and significant fibrosis were defined by controlled attenuation parameter (CAP) at least 248 dB/m and liver stiffness measurement (LSM) at least 7.1 kPa, respectively. Participants with viral hepatitis, hazardous alcohol consumption, and unsuppressed HIV viral load were excluded from the analysis. Logistic regression was used to estimate odds ratios, adjusting for study site, CD4 + T cell count, stavudine and didanosine exposure, and in models stratified by sex and geographic region.
There were 1750 participants from nine LMIC. Median CVD risk was 3% for both nonlaboratory and laboratory-based models. Adjusted odds ratios (ORs) for steatosis and significant fibrosis associated with laboratory CVD risk (≥10 vs. <5%) were OR = 1.83 [95% confidence interval (95% CI) = 1.21-2.76; P = 0.004] and OR = 1.62 (95% CI = 0.85-3.07; P = 0.14), respectively. Associations of CVD risk with steatosis were stronger in men and among participants at study sites outside Africa.
Higher CVD risk was associated with steatosis but not with significant fibrosis in PWH in our LMIC cohort.
本研究旨在了解中低收入国家（LMIC）中至少40岁且正在接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLWH）的心血管疾病（CVD）风险与肝脏脂肪变性和纤维化之间的关系。
我们使用了2020 - 2022年在国际流行病学数据库哨兵研究网络（IeDEA的SRN）研究入组访视期间收集的横断面行为和临床数据。
使用2019年世界卫生组织非实验室和实验室模型计算10年CVD风险。使用瞬时弹性成像评估肝脏疾病。脂肪变性和显著纤维化的存在分别通过控制衰减参数（CAP）至少248 dB/m和肝脏硬度测量（LSM）至少7.1 kPa来定义。分析排除了患有病毒性肝炎、有害饮酒和未抑制的艾滋病毒病毒载量的参与者。使用逻辑回归估计比值比，并对研究地点、CD4 + T细胞计数、司他夫定和去羟肌苷暴露进行调整，以及在按性别和地理区域分层的模型中进行调整。
来自9个中低收入国家的1750名参与者。非实验室和基于实验室的模型的CVD风险中位数均为3%。与实验室CVD风险（≥10% vs. <5%）相关的脂肪变性和显著纤维化的调整后比值比（OR）分别为OR = 1.83 [95%置信区间（95%CI）= 1.21 - 2.76；P = 0.004]和OR = 1.62（95%CI = 0.85 - 3.07；P = 0.14）。CVD风险与脂肪变性的关联在男性和非洲以外研究地点的参与者中更强。
在我们的中低收入国家队列中，较高的CVD风险与PLWH的脂肪变性相关，但与显著纤维化无关。
