Dong K L, Bausserman L L, Flynn M M, Dickinson B P, Flanigan T P, Mileno M D, Tashima K T, Carpenter C C
Department of Medicine, Brown University, Providence, Rhode Island, USA.
J Acquir Immune Defic Syndr. 1999 Jun 1;21(2):107-13.
Twenty-one women (propositi) who expressed serious concerns about changes in body habitus during highly active antiretroviral therapy (HAART) were evaluated by thorough physical examination, anthropometric measurements, and serum lipid and endocrine assays. The same evaluations were carried out in a comparison group of 21 women who received HAART but did not complain of changes in habitus. No significant demographic differences were found between the propositi and the comparison group, nor were there significant differences in CD4 count or plasma viral load (PVL) between the two groups. Lipid analyses were also performed on plasma obtained prior to HAART from 12 of the women. The frequency of changes reported by the 21 propositi were increase in abdominal size (90%), increase in breast size (71%), weight gain of >5 kg (43%), peripheral fat wasting (43%), buttock fat wasting (38%) and development of cervicodorsal fat pad (19%). A subset of patients in the comparison group experienced increase in abdominal size (29%) and weight gain >5 kg (19%), but none experienced clinically detectable peripheral or buttock fat wasting, increased breast size, or development of cervicodorsal fat pads. Mean waist circumference, waist-to-hip ratios (WHR), body fat, and body mass index (BMI) were above the desirable range for women in both propositi and the comparison group. Levels of total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol associated with increased cardiovascular risk were found in 48%, 62%, 45%, and 33%. respectively, of the propositi, with similar findings in the comparison group. Fasting insulin levels were elevated in 4 propositi and 6 of the comparison group; mean insulin levels were within the normal range for both groups. In the comparison of lipids for the subset of patients before and after HAART therapy, HAART was associated with significant increases in total cholesterol, apolipoprotein B, and HDL cholesterol. Changes in body habitus caused by redistribution of fat occur commonly in women receiving HAART. Serum lipid abnormalities also are common during HAART and appear to be as frequent in women who do not experience clinically apparent body fat redistribution as in those who do. The observed changes in body fat distribution and in serum lipid levels are alterations that have been strongly correlated with increased risk for cardiovascular disease. Therefore, an understanding of the basis of these phenomena, and the risks with which they may be associated in this population, will be important for therapeutic decision making in women with HIV disease.
对21名在高效抗逆转录病毒治疗（HAART）期间对身体形态变化表示严重担忧的女性（先证者）进行了全面体格检查、人体测量以及血脂和内分泌检测。对21名接受HAART但未主诉身体形态变化的女性组成的对照组进行了同样的评估。先证者与对照组在人口统计学方面未发现显著差异，两组的CD4细胞计数或血浆病毒载量（PVL）也无显著差异。还对12名女性HAART治疗前采集的血浆进行了血脂分析。21名先证者报告的变化频率为：腹部尺寸增加（90%）、乳房尺寸增加（71%）、体重增加超过5千克（43%）、外周脂肪消耗（43%）、臀部脂肪消耗（38%）以及颈背脂肪垫形成（19%）。对照组的一部分患者出现了腹部尺寸增加（29%）和体重增加超过5千克（19%），但无人出现临床上可检测到的外周或臀部脂肪消耗、乳房尺寸增加或颈背脂肪垫形成。先证者和对照组女性的平均腰围、腰臀比（WHR）、体脂和体重指数（BMI）均高于理想范围。48%、62%、45%和33%的先证者发现与心血管疾病风险增加相关的总胆固醇、甘油三酯、低密度脂蛋白（LDL）胆固醇和高密度脂蛋白（HDL）胆固醇水平升高，对照组也有类似发现。4名先证者和6名对照组患者的空腹胰岛素水平升高；两组的平均胰岛素水平均在正常范围内。在对HAART治疗前后患者亚组的血脂进行比较时，HAART与总胆固醇、载脂蛋白B和HDL胆固醇的显著升高有关。接受HAART治疗的女性中，因脂肪重新分布导致的身体形态变化很常见。HAART治疗期间血脂异常也很常见，在未出现临床上明显的身体脂肪重新分布的女性中似乎与出现这种情况的女性一样频繁。观察到的身体脂肪分布和血脂水平变化与心血管疾病风险增加密切相关。因此，了解这些现象的基础以及它们在该人群中可能相关的风险，对于HIV疾病女性的治疗决策至关重要。
