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Transient Elastography in HIV Infected Patients with Liver Steatosis Identifies a High-Risk Group for Non-Alcoholic Steatohepatitis
Current HIV Research ( IF 0.8 ) Pub Date : 2021-06-30 , DOI: 10.2174/1570162x19666210225085002
Marina Ferri Pezzini 1 , Hugo Cheinquer 2 , Alexandre de Araujo 2 , Carlos T Schmidt-Cerski 3 , Eduardo Sprinz 4 , Fernando Herz-Wolff 5 , Julia Poeta 6
Affiliation  

Objective: The study aimed to assess the role of TE in HIV-infected patients with NAFLD.

Methods: HIV-infected patients undergoing ART were enrolled between August 2016 and February 2017, following the inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria included pregnancy, alcohol intake ≥20g/day and co-infection with hepatitis B or C. Patients underwent an abdominal US to diagnose liver steatosis. Significant fibrosis (≥F2) was considered when APRI>1.0, FIB4>3 and liver stiffness ≥7.1kPa. Subjects with TE ≥7.1kPa were prescribed a liver biopsy and the NAFLD Scoring System ≥3 was considered as a diagnosis of NASH. The poisson regression model was used to identify factors associated with liver steatosis.

Results: 98 patients were included. The mean age of the subjects was 49±11 years and 53 (54.1%) were males. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male sex (PR= 2.18) and higher BMI (PR=1.08). Among the 31 patients with NAFLD, 26 showed results for TE, APRI and FIB4. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients (26.9%) had a TE result ≥7.1kPa, which was associated with higher triglyceride levels, FIB4 score and CAP values. Liver biopsy was perfomed on six of those with TE ≥7.1kPa and NASH was found in 5 (83.3%) and liver fibrosis without NASH in one.

Conclusion: NAFLD prevalence in HIV-infected patients is higher than the general population. TE ≥7.1kPa was not able to diagnose significant fibrosis but accurately detect a subgroup of patients at a high risk for NASH among HIV monoinfected individuals with steatosis.



中文翻译:

HIV 感染肝脂肪变性患者的瞬时弹性成像可确定非酒精性脂肪性肝炎的高危人群

目的:本研究旨在评估 TE 在 HIV 感染的 NAFLD 患者中的作用。

方法:在 2016 年 8 月至 2017 年 2 月期间招募接受 ART 的 HIV 感染患者,纳入标准:≥18 岁且 HIV 病毒载量检测不到。排除标准包括怀孕、酒精摄入量≥20g/天和合并感染乙型或丙型肝炎。患者接受腹部超声诊断肝脂肪变性。当 APRI>1.0、FIB4>3 且肝脏硬度≥7.1kPa 时考虑显着纤维化(≥F2)。TE≥7.1kPa的受试者进行肝活检,NAFLD评分系统≥3被认为是NASH的诊断。泊松回归模型用于识别与肝脂肪变性相关的因素。

结果:共纳入 98 例患者。受试者的平均年龄为 49±11 岁,其中 53 人(54.1%)为男性。31 名患者 (31.6%) 被诊断为肝脂肪变性,并且与男性 (PR=2.18) 和较高的 BMI (PR=1.08) 独立相关。在 31 名 NAFLD 患者中,26 名显示 TE、APRI 和 FIB4 结果。TE、APRI 和 FIB4 评估的显着纤维化患病率分别为 26.9%、6.4% 和 3.2%。7 名患者 (26.9%) 的 TE 结果≥7.1kPa,这与较高的甘油三酯水平、FIB4 评分和 CAP 值相关。其中 6 例 TE ≥ 7.1kPa 进行了肝活检,5 例 (83.3%) 发现 NASH,1 例未发现 NASH 肝纤维化。

结论:HIV感染者NAFLD患病率高于一般人群。TE ≥7.1kPa 无法诊断出明显的纤维化,但可以准确地检测出 HIV 单一感染者脂肪变性患者中 NASH 高风险的患者亚组。

更新日期:2021-08-30
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