HIV Unit, Infectious Diseases Service. Hospital Clínic of Barcelona, Barcelona, Spain.
Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer. (IDIBAPS), Barcelona, Spain.
HIV Med. 2024 Dec;25(12):1308-1324. doi: 10.1111/hiv.13730. Epub 2024 Nov 7.
Liver steatosis (LS) and liver fibrosis (LF) can increase the risk of cardiovascular disease in people with HIV, but their prevalence and associated factors are poorly understood. This study aimed to assess the prevalence of and factors associated with LS and LF in a large cohort of people with HIV.
We conducted a cross-sectional study of consecutive people with HIV attending the Clinic of Barcelona from September 2022 to September 2023, excluding those with chronic B or/and C hepatitis virus coinfection. LS was assessed using the Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI), and LF was assessed using the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), Fibrosis-4 score (FIB-4), and the European AIDS Clinical Society (EACS) algorithm in both the whole cohort (cohort 1) and in a specific cohort more susceptible to liver disease (cohort 2). We identified independent variables associated with LS and LF using logistic regression.
Cohort 1 included 4664 people with HIV; 76% and 37% of them had available HSI and FLI data, LS was present in 28% and 19%, respectively. LF risk was present in 1%, 2%, and 1% of people with HIV according to NFS, FIB-4, and EACS algorithm scores, respectively. Cohort 2 included 1345 people with HIV; 60% and 30% of them had available HSI and FLI data, LS affected 55% and 43% and LF 2%, 5%, or 3%, respectively. Factors associated with LS included current CD4 cell count, diabetes, and hypertension, whereas LF was associated with previous exposure to dideoxynucleoside drugs and current CD4 to LF. Current integrase strand transfer inhibitor (INSTI) therapy appeared protective for LF in cohort 1.
In this study, one in four people with HIV had LS, and the prevalence rose to one in two in those with cardiovascular risk factors. The prevalence of LF was low, but it should be considered in older people with HIV with low CD4 counts or high aspartate transaminase levels. A possible protective effect from INSTIs deserves further investigation.
肝脂肪变性（LS）和肝纤维化（LF）会增加 HIV 感染者患心血管疾病的风险，但人们对其患病率和相关因素知之甚少。本研究旨在评估在一个大型 HIV 感染者队列中 LS 和 LF 的患病率和相关因素。
我们进行了一项横断面研究，纳入了 2022 年 9 月至 2023 年 9 月期间在巴塞罗那临床诊所连续就诊的 HIV 感染者，排除了慢性 B 型和/或 C 型肝炎病毒合并感染的患者。使用肝脂肪变性指数（HSI）和脂肪肝指数（FLI）评估 LS，使用非酒精性脂肪性肝病纤维化评分（NFS）、纤维化-4 评分（FIB-4）和欧洲艾滋病临床学会（EACS）算法评估 LF，评估范围包括整个队列（队列 1）和更易发生肝病的特定队列（队列 2）。我们使用逻辑回归识别与 LS 和 LF 相关的独立变量。
队列 1 纳入了 4664 名 HIV 感染者；其中 76%和 37%的人有 HSI 和 FLI 数据，LS 的患病率分别为 28%和 19%。根据 NFS、FIB-4 和 EACS 算法评分，HIV 感染者 LF 风险分别为 1%、2%和 1%。队列 2 纳入了 1345 名 HIV 感染者；其中 60%和 30%的人有 HSI 和 FLI 数据，LS 的患病率分别为 55%和 43%，LF 分别为 2%、5%或 3%。与 LS 相关的因素包括当前 CD4 细胞计数、糖尿病和高血压，而 LF 与先前使用双脱氧核苷药物和当前 CD4 与 LF 相关。队列 1 中，当前整合酶抑制剂（INSTI）治疗似乎对 LF 有保护作用。
在这项研究中，四分之一的 HIV 感染者存在 LS，而在有心血管危险因素的患者中，患病率上升到二分之一。LF 的患病率较低，但对于 CD4 计数较低或天冬氨酸转氨酶水平较高的老年 HIV 感染者应考虑 LF。INSTI 可能具有保护作用，值得进一步研究。
