The Risk of Cardiovascular Disease, Diabetes, Liver-Related Outcomes, and Death Over 10 Years in HIV/HCV-Coinfected Patients With and Without Steatosis
The Risk of Cardiovascular Disease, Diabetes, Liver-Related Outcomes, and Death Over 10 Years in HIV/HCV-Coinfected Patients With and Without Steatosis
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DOI：
10.1089/aid.2016.0051
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发表时间：
2016-09-01
影响因子：
1.5
通讯作者：
Marks, Kristen
中科院分区：
文献类型：
--
作者：
Down, Carrie;Mehta, Natasha;Marks, Kristen
背景资料：与单纯感染HCV或HIV的患者相比，HIV/HCV合并感染与更严重的肝脏疾病相关，包括脂肪变性和显著纤维化的频率增加。我们试图探索脂肪变性对心血管疾病（CVD）、肝脏相关结局和生存率的影响。方法：进行IRB批准的单中心回顾性队列研究，分析HIV/HCV合并感染患者的10年临床结局。在研究入组时进行肝活检，以评价HCV疾病;研究病理学家对样本进行纤维化和脂肪变性分级。临床结果，包括心脏事件，FIB-4肝功能，AST与血小板比率指数，和生存超过10年进行了评估。结果：入组时，N=105，平均年龄457岁，70%为男性，56%活检时存在脂肪变性。在10年的随访中，与非脂肪变性组相比，脂肪变性组的CVD事件、非侵入性肝纤维化指标的变化或生存率之间没有发现相关性。然而，观察到了非显著趋势。总的来说，10年内合并感染人群的死亡率为25%，肝脏疾病是最常见的死亡原因。结论：鉴于大约一半的合并感染患者中脂肪变性的患病率，需要进行更大规模的研究来确定脂肪变性是否与该人群中的心脏病，糖尿病或肝病进展相关。此外，该人群的10年死亡率非常高，强调了HCV治疗的重要性，需要更好地了解导致该人群生存率下降的其他变量。
Background: Coinfection with HIV/HCV is associated with more severe liver disease, including increased frequency of steatosis and significant fibrosis, compared to patients mono-infected with HCV or HIV. We sought to explore the impact of steatosis on cardiovascular disease (CVD), liver-related outcomes, and survival. Methods: An IRB-approved, single-center retrospective cohort study was undertaken to analyze 10-year clinical outcomes in HIV/HCV-coinfected patients. Liver biopsy was performed at study entry for the evaluation of HCV disease; a study pathologist graded samples for fibrosis and steatosis. Clinical outcomes, including cardiac events, liver function with FIB-4, AST to Platelet Ratio Index, and survival were assessed over 10 years. Results: At cohort entry N=105, mean age 457 years, 70% male, and 56% had steatosis present on biopsy. During the 10-year follow-up, no association was found between incident CVD, changes in noninvasive liver fibrosis measures, or survival in the steatosis group compared to nonsteatosis group. However, nonsignificant trends were noted. Overall, mortality for this coinfected population was 25% over 10 years, with liver disease as the most common cause of death. Conclusions: Given the prevalence of steatosis in approximately half of coinfected patients, larger studies are warranted to determine if steatosis is associated with cardiac disease, diabetes, or liver disease progression in this population. Furthermore, 10-year mortality for this population was very high, underscoring the importance of HCV treatment and need for a better understanding of other variables responsible for decreased survival in this population.