Báguena Carlos, Tomás Cristina, Muñoz Ángeles, Alcaraz Antonia, Martínez Maria Isabel, Martínez-Rodríguez Rodrigo, García-Villalba Eva, Bernal Enrique
Infectious Disease Unit, Reina Sofia University Hospital, Biomedical Research Institute of Murcia and Univeristy of Murcia, Murcia, Spain.
Open Forum Infect Dis. 2025 Jun 9;12(6):ofaf324. doi: 10.1093/ofid/ofaf324. eCollection 2025 Jun.
Hepatic steatosis, commonly associated with metabolic dysfunction-associated steatotic liver disease, is a growing but underdiagnosed concern in people with human immunodeficiency virus (HIV). This study evaluates the diagnostic accuracy of insulin resistance markers (homeostatic model assessment for insulin resistance, triglyceride-glucose [TyG], triglyceride-glucose-body mass index [TyG-BMI], and triglyceride/high-density lipoprotein cholesterol indices) for identifying moderate to severe hepatic steatosis in people with HIV using transient elastography (FibroScan).
We prospectively analyzed 235 people with HIV on antiretroviral therapy with suppressed viral loads (<50 RNA copies/mL). Moderate to severe hepatic steatosis was defined as a controlled attenuation parameter ≥269 dB/m. Insulin resistance markers were calculated and diagnostic performance was assessed using receiver operating characteristic curves.
Moderate to severe hepatic steatosis was detected in 48 patients (20.4%). These individuals had higher rates of diabetes, BMI, and waist circumference. Insulin resistance indices were significantly elevated in this group, with TyG-BMI demonstrating the highest diagnostic accuracy (area under the curve, 0.800 [95% confidence interval, .727-.873]), achieving 79.2% sensitivity and 61.3% specificity at a cutoff of 227.36.
Insulin resistance markers, especially TyG-BMI, may serve as practical, noninvasive tools for identifying moderate to severe hepatic steatosis in people with HIV, particularly in resource-limited settings where transient elastography is unavailable.
肝脂肪变性通常与代谢功能障碍相关脂肪性肝病有关，在人类免疫缺陷病毒（HIV）感染者中日益常见但诊断不足。本研究评估胰岛素抵抗标志物（胰岛素抵抗稳态模型评估、甘油三酯 - 葡萄糖[TyG]、甘油三酯 - 葡萄糖 - 体重指数[TyG - BMI]以及甘油三酯/高密度脂蛋白胆固醇指数）在使用瞬时弹性成像（FibroScan）识别HIV感染者中重度肝脂肪变性的诊断准确性。
我们前瞻性分析了235例接受抗逆转录病毒治疗且病毒载量被抑制（<50个RNA拷贝/mL）的HIV感染者。中重度肝脂肪变性定义为受控衰减参数≥269 dB/m。计算胰岛素抵抗标志物，并使用受试者工作特征曲线评估诊断性能。
48例患者（20.4%）检测出中重度肝脂肪变性。这些个体的糖尿病、BMI和腰围发生率较高。该组胰岛素抵抗指数显著升高，其中TyG - BMI显示出最高的诊断准确性（曲线下面积，0.800[95%置信区间，0.727 - 0.873]），在临界值为227.36时，敏感性达到79.2%，特异性达到61.3%。
胰岛素抵抗标志物，尤其是TyG - BMI，可作为识别HIV感染者中重度肝脂肪变性的实用、非侵入性工具，特别是在无法进行瞬时弹性成像的资源有限环境中。
