Tsekes G, Chrysos G, Douskas G, Paraskeva D, Mangafas N, Giannakopoulos D, Papanikolaou M, Georgiou E, Lazanas M C
2nd Department of Medicine and HIV Unit, Tzaneion General Hospital of Piraeus, Athens University Medical School, Athens, Greece.
HIV Med. 2002 Apr;3(2):85-90. doi: 10.1046/j.1468-1293.2002.00105.x.
In the era of highly active antiretroviral treatment (HAART), there are insufficient data regarding lipodystrophy syndromes in HIV-1-infected patients treated with regimens that do not include protease inhibitors (PIs). We studied changes in body composition in HIV-1-infected patients before and 2 years after starting a non-PI-containing antiretroviral treatment regimen.
We studied retrospectively the whole body dual energy X-ray absorptiometry (DEXA) scans of 23 PI-naive HIV-1-infected patients (17 males, six females), aged 37.4 +/- 9.3 years with mean CD4 count 401 +/- 130 cells/microL. Thirteen patients were on zidovudine (ZDV) + lamivudine (3TC) and 10 on ZDV + didanosine (ddI). Subjects were evaluated before the beginning of antiretroviral treatment and approximately 24 months later. For each patient body weight, CD4 T-cell counts, bone mineral content (BMC), bone mineral density (BMD) and whole body as well as regional fat and lean body mass were evaluated.
A significant decrease in BMC was observed, although the T scores remained within the normal limits. Our patients also exhibited a significant decrease in body weight due almost exclusively to fat loss, while lean mass was minimally affected. Fat loss was statistically significant in the arms and legs, but not in the trunk. The above changes were most prominent in the ZDV + 3TC treatment group; in this group of patients, fat loss was also evident in the trunk. Patients on ZDV + ddI, on the other hand, only showed a significant increase in their legs' lean mass; they preserved their total fat mass and exhibited no other significant changes between the two assessments.
Dual NRTI therapy contributes to fat loss and reduction of bone mineral content in otherwise healthy, clinically stable, PI-naive HIV-infected adults. Compared with patients on ZDV + ddI, patients on ZDV + 3TC had a more prominent fat loss in all body regions.
在高效抗逆转录病毒治疗（HAART）时代，关于未使用蛋白酶抑制剂（PI）方案治疗的HIV-1感染患者的脂肪代谢障碍综合征的数据不足。我们研究了HIV-1感染患者在开始不含PI的抗逆转录病毒治疗方案之前及之后2年的身体成分变化。
我们回顾性研究了23例未接受过PI治疗的HIV-1感染患者（17例男性，6例女性）的全身双能X线吸收法（DEXA）扫描结果，这些患者年龄为37.4±9.3岁，平均CD4细胞计数为401±130个/微升。13例患者接受齐多夫定（ZDV）+拉米夫定（3TC）治疗，10例接受ZDV+去羟肌苷（ddI）治疗。在抗逆转录病毒治疗开始前及约24个月后对受试者进行评估。对每位患者的体重、CD4 T细胞计数、骨矿物质含量（BMC）、骨矿物质密度（BMD）以及全身和局部的脂肪和瘦体重进行评估。
观察到BMC显著下降，尽管T值仍在正常范围内。我们的患者体重也显著下降，几乎完全是由于脂肪减少，而瘦体重受影响最小。手臂和腿部的脂肪减少具有统计学意义，但躯干部位没有。上述变化在ZDV+3TC治疗组最为明显；在该组患者中，躯干部位也出现明显的脂肪减少。另一方面，接受ZDV+ddI治疗的患者仅腿部瘦体重显著增加；他们的总脂肪量保持不变，两次评估之间未出现其他显著变化。
双重核苷类逆转录酶抑制剂疗法会导致原本健康、临床稳定、未接受过PI治疗的HIV感染成年人出现脂肪减少和骨矿物质含量降低。与接受ZDV+ddI治疗的患者相比，接受ZDV+3TC治疗的患者在身体所有部位的脂肪减少更为明显。
