Li Jiajing, Zhou Jiahua, Li Pengfei, Wang Yining, Ridderhof Nathalie, Al-Tawfiq Jaffar A, Brouwer Willem Pieter, Chen Kan, de Knegt Robert J, Peppelenbosch Maikel P, Hansen Bettina E, Engel Maarten F M, Zheng Ming-Hua, Memish Ziad A, Eslam Mohammed, Janssen Harry L A, Pan Qiuwei, Ayada Ibrahim
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Hepatol Commun. 2025 Apr 14;9(5). doi: 10.1097/HC9.0000000000000689. eCollection 2025 May 1.
Steatotic liver disease (SLD) affects ~30% of adults worldwide. The global population is continuously threatened by epidemic and endemic viral diseases. This study aims to thoroughly examine the interaction between SLD and major viral diseases.
We systematically searched databases from inception to April 2, 2024, for observational studies recording viral-infected adult patients with eligible data on the presence of hepatic steatosis.
Six hundred thirty-six eligible studies were included in the analysis of SLD prevalence. Among patients with monoinfections, the highest SLD prevalence was observed in those infected with HCV at 49% (95% CI: 47%-51%), followed by SARS-CoV-2 (39%, 95% CI [34%-44%]), HIV (39%, 95% CI [33%-44%]), and HBV (36%, 95% CI [32%-40%]). Additionally, co-infections, such as HCV-HIV and HBV-HCV, exhibit even higher SLD prevalence. The prevalence of steatohepatitis is particularly high in HIV-infected (24%, 95% CI: 17%-30%) and HCV-infected (18%, 95% CI: 13%-24%) populations. The co-existence of SLD with viral infections was associated not only with the progression of liver disease but also with more severe outcomes of the infections and poorer responses to antiviral treatment. The combination of cardiometabolic risk factors and viral-associated and host factors contributes to the higher risk of SLD in viral-infected populations.
SLD is highly prevalent in viral-infected populations, and the reciprocal interactions between SLD and viral diseases exacerbate both conditions, leading to poorer patient outcomes in general.
脂肪性肝病（SLD）影响着全球约30%的成年人。全球人口持续受到流行性和地方性病毒疾病的威胁。本研究旨在全面考察SLD与主要病毒性疾病之间的相互作用。
我们系统检索了从数据库建立至2024年4月2日的数据库，以查找记录有符合条件的肝脂肪变性数据的病毒感染成年患者的观察性研究。
636项符合条件的研究纳入了SLD患病率分析。在单一感染患者中，丙型肝炎病毒（HCV）感染患者的SLD患病率最高，为49%（95%置信区间：47%-51%），其次是严重急性呼吸综合征冠状病毒2（SARS-CoV-2，39%，95%置信区间[34%-44%]）、人类免疫缺陷病毒（HIV，39%，95%置信区间[33%-44%]）和乙型肝炎病毒（HBV，36%，95%置信区间[32%-40%]）。此外，合并感染，如HCV-HIV和HBV-HCV，表现出更高的SLD患病率。脂肪性肝炎的患病率在HIV感染人群（24%，95%置信区间：17%-30%）和HCV感染人群（18%，95%置信区间：13%-24%）中尤其高。SLD与病毒感染的共存不仅与肝病进展相关，还与感染的更严重后果以及对抗病毒治疗的较差反应相关。心脏代谢危险因素与病毒相关因素和宿主因素的组合导致病毒感染人群中SLD风险更高。
SLD在病毒感染人群中高度流行，SLD与病毒性疾病之间的相互作用加剧了这两种情况，总体上导致患者预后更差。
