巨细胞病毒血清阳性hiv病毒抑制患者的肝纤维化和脂肪变性

C. Jasirwan, A. Wibowo, A. Sjaaf, Gita Aprilicia, Dyah Purnamasari, E. Yunihastuti, R. Gani
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摘要

背景:巨细胞病毒(CMV)是一种常见于人类免疫缺陷病毒(HIV)患者的人类疱疹病毒。在具有免疫能力的患者中,长周期的无症状巨细胞病毒可能会导致肝功能异常,并导致非艾滋病定义的发病率,包括慢性肝病。本研究旨在了解CMV反应性病毒抑制HIV感染患者肝纤维化和脂肪变性的患病率,并总结这些患者的临床表现与肝纤维化和脂肪变性的相关性。方法:于2019年4月至2020年6月在Cipto Mangunkusumo医院HIV综合护理病房进行横断面研究。本研究的受试者年龄在30-40岁之间,IgG巨细胞病毒阳性,并且已经使用稳定的抗逆转录病毒治疗至少一年。瞬时弹性图测量肝脏刚度。肝僵硬度大于7 kPa的患者定义为肝纤维化明显。此外,采用Spearman相关性来评价肝纤维化和脂肪变性与受试者临床表现的相关性。结果:本研究共纳入受试者。男性居多(62.5%),平均年龄38±4.68岁。CMV DNA的中位数为466(17-21284)拷贝/ml。80例受试者中有17例(21%)出现显著纤维化。在本研究中,与肝纤维化相关的临床参数有胰岛素、空腹血糖、Homa IR、甘油三酯、HDL和血小板。胰岛素与Homa IR呈中等正相关,Homa IR与胰岛素的相关系数为r = 0.475, p 0.001;Homa IR相关系数r = 0.487, p 0.001。结论:肝纤维化发生率为12%。此外,胰岛素和Homa IR与肝纤维化增加呈正相关。
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Liver Fibrosis and Steatosis in Virally Suppressed HIV-Infected Patients with Cytomegalovirus Seropositivity
Background: Cytomegalovirus (CMV) is a human herpesvirus common in people with human immunodeficiency virus (HIV). In a patient with immunocompetence, long periodic asymptomatic CMV might affect to develop the abnormal liver function and contribute to non-AIDS defining morbidity, including chronic liver disease. This study aims to know the prevalence of liver fibrosis and steatosis in virally suppressed HIV infected patients with CMV reactive and summarize the correlation of clinical presentation with liver fibrosis and steatosis in these subjects.Method: A cross-sectional study in HIV Integrated Care Unit, Cipto Mangunkusumo Hospital, was conducted from April 2019 until June 2020. Subjects enrolled in this study were suppressed HIV patients aged between 30-40 years with positive IgG CMV and already using stable ART for at least one year. Transient elastography measured the liver stiffness. Patients with liver stiffness above 7 kPa were defined as having significant liver fibrosis. In addition, Spearman correlation was conducted to evaluate the correlation of clinical presentation of subjects related to liver fibrosis and steatosis. Results: A total of subjects was included in this study. Dominantly male (62.5%) with average age 38 ± 4.68 years. The median amount of CMV DNA was 466 (17-21284) copy/ml. Significant Fibrosis was found in 17/80 (21%) subjects. In this study, clinical parameters correlated with liver fibrosis were insulin, glucose fasting, Homa IR, triglyceride, HDL, and platelet. A medium positive correlation was found in insulin, and Homa IR, with coefficient correlation for insulin, was r = 0.475, p 0.001; and coefficient correlation for Homa IR was r = 0 .487, p 0.001.Conclusion: The prevalence of liver fibrosis was 12% in these subjects. In addition, insulin and Homa IR had a positive correlation with increasing liver fibrosis.
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