Michel Maurice, Hagström Hannes, Widman Linnea, Nowak Piotr, Shang Ying, Schattenberg Jörn M, Wester Axel
Department of Internal Medicine II, University Medical Centre Saarland, Homburg, Germany.
Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Gastro Hep Adv. 2024 Jun 4;3(6):783-792. doi: 10.1016/j.gastha.2024.05.009. eCollection 2024.
People living with human immunodeficiency virus (HIV) (PLWH) show a high incidence of chronic liver disease (CLD). However, whether HIV is associated with major adverse liver outcomes (MALO) in patients with underlying CLD remains to be determined.
In this population-based cohort study, data were retrieved from the Swedish National Patient Register to identify PLWH and CLD (n = 2375) or CLD without HIV (n = 144,346) between 1997 and 2020. The cumulative incidence of MALO was calculated while accounting for competing risks (non-MALO death). Incidence rates per 1000 person-years were compared between the exposure groups (HIV vs no HIV) with Cox regression to estimate adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs).
The incidence rate per 1000 person-years of MALO was lower in PLWH (5.1, 95% CI 4.2-6.1) compared to patients without HIV (13.1, 95% CI 12.9-13.3). This translated into an adjusted HR of 0.77 (95% CI 0.64-0.93), driven by a lower rate of hepatocellular carcinoma (adjusted HR = 0.61, 95% CI 0.43-0.86). Consistent results were noted across a range of subgroup analyses. The 10-year cumulative incidence of MALO was lower in PLWH (5.0%, 95% CI 4.1-6.1) than in patients without HIV (10.9%, 95% CI 10.7-11.0).
Among patients with CLD, the risk of MALO was lower in PLWH compared to those without HIV, primarily due to a lower incidence of hepatocellular carcinoma. These results suggest that HIV is not associated with a higher risk of MALO.
人类免疫缺陷病毒（HIV）感染者（PLWH）的慢性肝病（CLD）发病率较高。然而，HIV是否与潜在CLD患者的主要不良肝脏结局（MALO）相关仍有待确定。
在这项基于人群的队列研究中，从瑞典国家患者登记处检索数据，以确定1997年至2020年间的PLWH和CLD患者（n = 2375）或无HIV的CLD患者（n = 144,346）。计算MALO的累积发病率，同时考虑竞争风险（非MALO死亡）。通过Cox回归比较暴露组（HIV感染者与非HIV感染者）每1000人年的发病率，以估计调整后的风险比（HR）及其95%置信区间（CI）。
与未感染HIV的患者（13.1，95%CI 12.9 - 13.3）相比，PLWH每1000人年的MALO发病率较低（5.1，95%CI 4.2 - 6.1）。这转化为调整后的HR为0.77（95%CI 0.64 - 0.93），主要是由于肝细胞癌的发病率较低（调整后的HR = 0.61，95%CI 0.43 - 0.86）。在一系列亚组分析中均观察到一致的结果。PLWH的10年MALO累积发病率（5.0%，95%CI 4.1 - 6.1）低于未感染HIV的患者（10.9%，95%CI 10.7 - 11.0）。
在CLD患者中，PLWH的MALO风险低于未感染HIV的患者，主要原因是肝细胞癌的发病率较低。这些结果表明，HIV与MALO风险较高无关。
