Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus
Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus
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DOI：
10.1097/01.aids.0000163935.99401.25
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发表时间：
2005-04-08
期刊：
影响因子：
3.8
通讯作者：
Thomas, DL
中科院分区：
文献类型：
--
作者：
Sulkowski, MS;Mehta, SH;Thomas, DL
目的：为了确定合并感染HIV和丙型肝炎病毒（HCV）并接受抗逆转录病毒治疗（ART）的患者中肝脏脂肪变性的患病率和严重程度;调查脂肪变性是否与更晚期的肝脏疾病相关，并确定可能导致该过程的因素。方法：在约翰霍普金斯大学艾滋病诊所的一项队列研究中，对随机选择的接受至少2年抗逆转录病毒治疗的HIV-HCV合并感染患者的脂肪变性进行了评估。由一名病理学家评价肝脏组织学。主要结果指标为肝脂肪变性分级，分为5个等级：0，无; 1，脂肪变性累及< 5%的肝细胞; 2，5-29%; 3，30-60%; 4 > 60%。结果：对112例患者进行了肝组织学评估，其中74%在活检时正在接受ART治疗。核苷类逆转录酶抑制剂和蛋白酶抑制剂的中位累积暴露时间分别为5.8年和3.7年。60%未检测到脂肪变性; 18%识别出2-4级脂肪变性。在多变量分析中，脂肪变性与白种人、体重> 86 kg、高血糖和司他夫定使用独立相关。脂肪变性患者也更有可能有更大的肝纤维化（P = 0.02）和坏死性炎症活动（P = 0.005）。结论：脂肪变性观察到40%的艾滋病毒-丙型肝炎病毒合并感染患者广泛的抗逆转录病毒药物暴露，并与更严重的丙型肝炎病毒相关的肝脏疾病。代谢异常（超重和高血糖）和司他夫定的使用是该人群脂肪变性的可改变的危险因素。(c)2005年利平科特威廉姆斯&威尔金斯。
Objective: To ascertain the prevalence and severity of hepatic steatosis among patients coinfected with HIV and hepatitis C virus (HCV) who had been taking antiretroviral therapy (ART); to investigate if steatosis is associated with more advanced liver disease, and to identify factors that might contribute to the process.Methods: Steatosis was assessed among a randomly selected subset of HIV-HCV-coinfected patients who had received at least 2 years of ART in a cohort study at the Johns Hopkins University HIV clinic. Liver histology was evaluated by a single pathologist. The primary outcome measure was the hepatic steatosis grade, which was classified on a 5 point scale: 0, none; 1, steatosis involving < 5% of hepatocytes; 2, 5-29%; 3, 30-60%; 4 > 60%.Results: Liver histology was assessed in 112 patients, 74% of whom were taking ART at the time of biopsy. The median cumulative exposure to nucleoside reverse transcriptase inhibitors and protease inhibitors was 5.8 and 3.7 years, respectively. No steatosis was detected in 60%; grades 2-4 steatosis was recognized in 18%. In multivariate analysis, steatosis was independently associated with Caucasian race, weight > 86 kg, hyperglycemia, and stavudine use. Patients with steatosis also were more likely to have greater hepatic fibrosis (P = 0.02) and necroinflammatory activity (P = 0.005).Conclusions: Steatosis was observed in 40% of HIV-HCV-coinfected patients with extensive ART exposure and was associated with more severe HCV-related liver disease. Metabolic abnormalities (excess weight and hyperglycemia) and stavudine use were modifiable risk factors for steatosis in this population. (c) 2005 Lippincott Williams & Wilkins.