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.

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。