Clémence Ramier, Anders Boyd, Colette Smit, Rosan van Zoest, Mark A. A. Claassen, Katalin Pogány, Dirk Posthouwer, Theodora E. M. S. de Vries-Sluijs, Patrizia Carrieri, Marc Van der Valk
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Severe liver disease (i.e., significant fibrosis (≥F2), cirrhosis, hepatocellular carcinoma, liver transplantation) was defined by physician diagnosis or a transient elastography result > 7 kPa. Determinants of incident liver disease were assessed using Cox proportional hazard models.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the 1319 individuals included (12,277 person-years (PY); 93.3% HIV-RNA < 200 copies/ml), the incidence rate of severe liver disease was 0.59 per 100 PY [95% confidence interval (CI) = 0.47–0.75]. After adjustment for age and time since HBV diagnosis, tobacco smoking, HCV coinfection and body mass index > 25 kg/m<sup>2</sup> increased the risk of liver disease [adjusted hazards ratio (aHR) = 2.33, 95% CI = 1.38–3.94; aHR = 4.00, 95% CI = 2.18–7.33, aHR = 1.75, 95% CI = 1.05–2.92, respectively]. Conversely, men who have sex with men (vs. other transmission routes, aHR = 0.54, 95% CI = 0.32–0.90), and individuals living in an urbanised municipality (aHR = 0.50, 95% CI = 0.30–0.85) had a reduced risk of liver disease.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Liver disease progression in people living with HIV/HBV appears to be linked to psychosocial/behavioural factors. 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引用次数: 0
摘要
背景和目的社会人口学和行为因素对HIV和慢性乙型肝炎病毒（HBV）合并感染个体发生肝脏疾病的贡献知之甚少。我们的目的是量化这些因素对荷兰接受治疗的HIV/HBV患者发生肝脏疾病的影响。方法采用荷兰观察性ATHENA队列联合荷兰统计局的数据。我们纳入了2008-2022年间所有乙型肝炎表面抗原阳性的HIV患者。严重肝脏疾病（即显著纤维化（≥F2）、肝硬化、肝细胞癌、肝移植）由医师诊断或瞬时弹性成像结果[gt； 7 kPa]确定。使用Cox比例风险模型评估肝脏疾病发生的决定因素。结果纳入1319例个体（12277人-年）；93.3% HIV-RNA <； 200拷贝/ml)，严重肝病的发病率为0.59 / 100 PY[95%可信区间(CI) = 0.47-0.75]。调整年龄和诊断HBV后的时间、吸烟、HCV合并感染和体重指数后；25 kg/m2增加肝脏疾病的风险[校正危险比(aHR) = 2.33, 95% CI = 1.38 ~ 3.94；aHR = 4.00, 95% CI -7.33 = 2.18, aHR = 1.75, 95% CI -2.92 = 1.05,分别)。相反，男男性行为者（与其他传播途径相比，aHR = 0.54, 95% CI = 0.32-0.90）和生活在城市化城市的人（aHR = 0.50, 95% CI = 0.30-0.85）患肝病的风险较低。结论：HIV/HBV感染者的肝病进展似乎与社会心理/行为因素有关。临床随访应包括对合并感染和代谢综合征更有效的筛查/管理，以及戒烟策略。
Impact of Socio-Economic, Behavioural and Clinical Factors on Liver Disease Progression in Individuals With HIV and Hepatitis B
Background and Aims
Little is known about the contribution of sociodemographic and behavioural factors to developing liver disease in individuals with an HIV and chronic hepatitis B virus (HBV) co-infection. We aimed to quantify the impact of these factors on incident liver disease in individuals with HIV/HBV receiving care in the Netherlands.
Methods
We used data from the Dutch observational ATHENA cohort combined with Statistics Netherlands. We included all hepatitis B surface antigen-positive individuals with HIV in care from 2008–2022. Severe liver disease (i.e., significant fibrosis (≥F2), cirrhosis, hepatocellular carcinoma, liver transplantation) was defined by physician diagnosis or a transient elastography result > 7 kPa. Determinants of incident liver disease were assessed using Cox proportional hazard models.
Results
In the 1319 individuals included (12,277 person-years (PY); 93.3% HIV-RNA < 200 copies/ml), the incidence rate of severe liver disease was 0.59 per 100 PY [95% confidence interval (CI) = 0.47–0.75]. After adjustment for age and time since HBV diagnosis, tobacco smoking, HCV coinfection and body mass index > 25 kg/m2 increased the risk of liver disease [adjusted hazards ratio (aHR) = 2.33, 95% CI = 1.38–3.94; aHR = 4.00, 95% CI = 2.18–7.33, aHR = 1.75, 95% CI = 1.05–2.92, respectively]. Conversely, men who have sex with men (vs. other transmission routes, aHR = 0.54, 95% CI = 0.32–0.90), and individuals living in an urbanised municipality (aHR = 0.50, 95% CI = 0.30–0.85) had a reduced risk of liver disease.
Conclusions
Liver disease progression in people living with HIV/HBV appears to be linked to psychosocial/behavioural factors. More effective screening/management of coinfection and metabolic syndrome, as well as strategies for smoking cessation, should be included in clinical follow-up.
期刊介绍：
Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.
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