BackgroundNonalcoholic fatty liver disease (NAFLD) is an increasing concern for people living with HIV (PLWH). However, information on the impact of NAFLD on the prognosis of PLWH is very scarce.AimsTo investigate the influence of NAFLD on the overall and liver‐related mortality in PLWH.MethodsPLWH followed in three Spanish centres were included in a prospective cohort at the date of the first transient elastography evaluation. Survival data were recorded, and the causes of death were centrally monitored. The risk of all‐cause death and liver‐related death was evaluated by applying time‐to‐event analyses.ResultsA total of 2151 PLWH were included in the cohort and followed for a median (Q1–Q3) of 7.3 (3.5–10.4) years. There were 174 (8.1%) deaths. The probability of overall death and liver‐related death was associated with liver stiffness measurement (LSM) and with FibroScan‐AST (FAST) score. Among 844 PLWH with potential for NALFD, LSM was independently associated with all‐cause mortality (adjusted hazard ratio [AHR], by 1 kPa increase: 1.06; 95% confidence interval [95% CI]: 1.04–1.08; p < 0.001). In a separate model and after adjustment, FAST score ≥ 0.67 was related to survival (AHR: 1.87; 95% CI: 1.40–2.50; p < 0.001). The AUROC (95% CI) of the models were based on LSM, 0.812 (0.739–0.885); and FAST, 0.825 (0.753–0.897) (p = 0.386).ConclusionsFor PLWH, advanced liver fibrosis increases the risk of overall death and liver‐related death. LSM and the FAST score are similar predictors of survival for PLWH with potential for NAFLD.

中文翻译：

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非酒精性脂肪肝病对 HIV 感染者生存的影响


背景非酒精性脂肪性肝病 （NAFLD） 是 HIV 感染者 （PLWH） 日益关注的问题。然而，关于 NAFLD 对 PLWH 预后影响的信息非常稀少。目的探讨 NAFLD 对 PLWH 总死亡率和肝脏相关死亡率的影响。方法在第一次瞬时弹性成像评估之日，在三个西班牙中心跟踪的 PLWH 被纳入前瞻性队列。记录生存数据，集中监测死因。通过应用事件发生时间分析来评估全因死亡和肝脏相关死亡的风险。结果队列共纳入 2151 例 PLWH，随访中位 （Q1-Q3） 为 7.3 （3.5-10.4） 年。有 174 例 （8.1%） 死亡。总死亡和肝脏相关死亡的概率与肝脏硬度测量 （LSM） 和 FibroScan-AST （FAST） 评分相关。在 844 例可能发生 NALFD 的 PLWH 中，LSM 与全因死亡率独立相关（校正风险比 [AHR]，增加 1 kPa：1.06;95% 置信区间 [95% CI]：1.04-1.08;p < 0.001）。在单独的模型中，经过调整，FAST 评分≥ 0.67 与生存率相关 （AHR： 1.87;95% CI： 1.40–2.50;p < 0.001）。模型的 AUROC （95% CI） 基于 LSM，0.812 （0.739–0.885）;和 FAST，0.825 （0.753–0.897） （p = 0.386）。结论对于 PLWH，晚期肝纤维化增加了总体死亡和肝脏相关死亡的风险。LSM 和 FAST 评分是 PLWH 生存率的相似预测因子，可能患有 NAFLD。