Yu Nawei, Di Xiaoyun, Xia Zihao, Peng Jingli, Zhong Mingli, Li Mengqing, Guan Hongjing, Chen Chen, Cai Rentian, Wei Hongxia
Department of Infectious Disease, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
Department of Infectious Disease, The School of Public Health of Nanjing Medical University, The Second Hospital of Nanjing, Nanjing, Jiangsu Province, China.
Medicine (Baltimore). 2025 May 30;104(22):e41261. doi: 10.1097/MD.0000000000041261.
To investigate the prevalence of liver injury and the factors influencing severe liver injury in antiretroviral therapy (ART)-naïve patients with human immunodeficiency virus (HIV) infection. ART-naïve HIV-1 infected patients who visited the outpatient department of the Infection Department of the Second Hospital of Nanjing between January 1, 2005, and May 31, 2022, were included in the study. The clinical data of patients with baseline liver injury were retrospectively collected. Liver injury was classified as grade 1, 2, 3, or 4 according to the severity scale of adverse events in adults and children with acquired immunodeficiency syndrome (AIDS), based on the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL). A total of 982 patients were included in the analysis. The overall prevalence of liver injury (grades 1-4) was 19.3% (982/5099), with grade 1 liver injury (75.9%, 745/982) be the most common. Multivariate logistic regression analysis revealed that high-density lipoprotein cholesterol (HDL-C) was a protective factor against severe liver injury (odds ratio [OR] = 0.28, 95% CI = 0.08-0.99, P = .048). Conversely, hepatitis B virus (HBV) infection (OR = 4.02, 95% CI = 1.82-8.88, P = .001) elevated gamma-glutamyl transpeptidase (GGT, OR = 1.04, 95% CI = 1.01-1.06, P = .004), and elevated levels of lactic dehydrogenase (LDH, OR = 1.03, 95% CI = 1.01-1.04, P = .002) were identified as independent risk factors for severe liver injury in newly treated HIV/AIDS patients. Liver injury is prevalent among HIV/AIDS patients who have not initiated ART. HDL-C, HBV infection, GGT, and LDH are significant factors influencing the severity of liver injury.
调查初治人类免疫缺陷病毒（HIV）感染患者肝损伤的患病率及影响严重肝损伤的因素。纳入2005年1月1日至2022年5月31日期间在南京医科大学第二附属医院感染科门诊就诊的初治HIV-1感染患者。回顾性收集基线肝损伤患者的临床资料。根据成人及儿童获得性免疫缺陷综合征（AIDS）不良事件严重程度量表，依据丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（TBIL）水平，将肝损伤分为1、2、3或4级。共982例患者纳入分析。肝损伤（1-4级）的总体患病率为19.3%（982/5099），其中1级肝损伤最为常见（75.9%，745/982）。多因素logistic回归分析显示，高密度脂蛋白胆固醇（HDL-C）是严重肝损伤的保护因素（比值比[OR]=0.28，95%可信区间[CI]=0.08-0.99，P=0.048）。相反，乙型肝炎病毒（HBV）感染（OR=4.02，95%CI=1.82-8.88，P=0.001）、γ-谷氨酰转肽酶（GGT）升高（OR=1.04，95%CI=1.01-1.06，P=0.004）以及乳酸脱氢酶（LDH）水平升高（OR=1.03，95%CI=1.01-1.04，P=0.002）被确定为新治疗的HIV/AIDS患者严重肝损伤的独立危险因素。肝损伤在未开始抗逆转录病毒治疗（ART）的HIV/AIDS患者中普遍存在。HDL-C、HBV感染、GGT和LDH是影响肝损伤严重程度的重要因素。
