Gervasoni C, Ridolfo A L, Trifirò G, Santambrogio S, Norbiato G, Musicco M, Clerici M, Galli M, Moroni M
Institute of Infectious Diseases and Tropical Medicine, L. Sacco Hospital, Milan, Italy.
AIDS. 1999 Mar 11;13(4):465-71. doi: 10.1097/00002030-199903110-00004.
To investigate the prevalence, metabolic features and risk factors of a particular pattern of fat redistribution (FR), characterized by a progressive enlargement of breast and abdominal girth associated with a wasting of the lower limbs, observed in HIV-infected women treated with combined antiretroviral (ARV) therapy.
Cross-sectional study.
Outpatients attending the Institute of Infectious Diseases, University of Milan, Milan, Italy.
HIV-infected women treated with two or more ARV drugs, observed between December 1997 and February 1998. FR was confirmed by means of a physical examination and dual-energy X-ray absorptiometry (DEXA). The metabolic and endocrinological measurements in patients with FR were compared with those in FR-free women.
FR was observed in 32 out of 306 women (10.5%). DEXA revealed more trunk fat (P < 0.01) and less leg fat (P < 0.001) in the patients with FR than in the matched controls. There were no significant differences in laboratory test results between the two groups. All of the FR patients were taking lamivudine-containing regimens; 20 of them were also taking a protease inhibitor (PI). The association of FR with lamivudine-including regimens was statistically significant (P = 0.017). Among the patients taking lamivudine, the risk associated with treatments including PI was 1.8 (95% CI 0.8-3.8, P = 0.12). A total duration of ARV therapy of more than 1000 days was associated with a greater risk of developing FR (OR 10.8; 95% CI 1.4-80.5; P = 0.0207). Stepwise logistic regression analyses indicated that prolonged ARV therapy and a viral load of more than 10000 copies per ml at the beginning of the last ARV regimen were the only variables that significantly and independently correlated with the risk of FR.
The observed body modifications are caused by a redistribution of body fat without fat loss that is apparently not associated with hyperlipidemia, altered glucose metabolism or other endocrinological disorders. The development of FR in patients receiving only reverse transcriptase (RT) inhibitors suggests the presence of a PI-independent mechanism that deserves further investigation.
在接受联合抗逆转录病毒（ARV）治疗的HIV感染女性中，调查一种特殊的脂肪重新分布（FR）模式的患病率、代谢特征及危险因素，该模式的特点是乳房和腹围逐渐增大，同时伴有下肢消瘦。
横断面研究。
意大利米兰大学传染病研究所门诊。
1997年12月至1998年2月期间观察的接受两种或更多ARV药物治疗的HIV感染女性。通过体格检查和双能X线吸收法（DEXA）确认FR。将有FR的患者的代谢和内分泌测量结果与无FR的女性进行比较。
306名女性中有32名（10.5%）观察到FR。DEXA显示，有FR的患者比匹配的对照组有更多的躯干脂肪（P<0.01）和更少的腿部脂肪（P<0.001）。两组实验室检查结果无显著差异。所有FR患者都在服用含拉米夫定的治疗方案；其中20人还在服用蛋白酶抑制剂（PI）。FR与含拉米夫定治疗方案的关联具有统计学意义（P = 0.017）。在服用拉米夫定的患者中，包括PI的治疗相关风险为1.8（95%CI 0.8 - 3.8，P = 0.12）。ARV治疗总持续时间超过1000天与发生FR的风险更高相关（OR 10.8；95%CI 1.4 - 80.5；P = 0.0207）。逐步逻辑回归分析表明，延长ARV治疗和最后一个ARV治疗方案开始时病毒载量超过每毫升10000拷贝是与FR风险显著且独立相关的唯一变量。
观察到的身体改变是由身体脂肪重新分布引起的，没有脂肪丢失，且显然与高脂血症、糖代谢改变或其他内分泌紊乱无关。仅接受逆转录酶（RT）抑制剂治疗的患者中FR的发生提示存在一种不依赖PI的机制，值得进一步研究。
