Ammassari Adriana, Antinori Andrea, Cozzi-Lepri Alessandro, Trotta Maria Paola, Nasti Guglielmo, Ridolfo Anna Lisa, Mazzotta Francesco, Wu Albert W, d'Arminio Monforte Antonella, Galli Massimo
Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, Roma, Italy.
J Acquir Immune Defic Syndr. 2002 Dec 15;31 Suppl 3:S140-4. doi: 10.1097/00126334-200212153-00011.
Adipose tissue alterations (ATA), which are common among persons treated with highly active antiretroviral therapy (HAART), can have substantial psychologic repercussions, with a subsequent negative impact on the patient's quality of life and on HAART adherence. However, the cross-sectional nature of the studies precludes establishing the direction and causality of the relationship. The authors evaluated the longitudinal relationship between ATA and adherence to HAART. The analysis included all participants in the AdICoNA and the LipolCoNA substudies of the Italian Cohort Naive Antiretrovirals (ICoNA). Adherence was assessed using a 16-item self-administered questionnaire, which also included a question on self-perceived fat accumulation experienced during the past 4 weeks. ATA was diagnosed by physicians at enrollment and evaluated every 6 months thereafter. There were 207 patients, with a median age of 35 years; 73% were men; and 34% acquired HIV through injection drug use. At baseline, nonadherence was reported by 63% of participants, and ATA was self-perceived by 15% and clinically diagnosed in 25%. Using Cox regression analysis, patients with good adherence at baseline were more likely to develop ATA (RH = 2.58; 95% CI, 1.09-6.11) and developed it sooner. Self-perceived ATA at baseline was independently related to subsequent nonadherence (OR, 4.67; 95% CI, 1.01-22.4), but clinically diagnosed ATA was not (OR, 0.77; 95% CI, 0.37-1.61). Patients' adherence to HAART is a dynamic process that interacts with ATA. Better adherence is associated with a higher risk of subsequent occurrence of ATA, while patient-perceived onset of morphologic alterations can reduce adherence to antiretroviral therapy.
脂肪组织改变（ATA）在接受高效抗逆转录病毒治疗（HAART）的人群中很常见，可能会产生重大的心理影响，进而对患者的生活质量和HAART治疗依从性产生负面影响。然而，这些研究的横断面性质使得无法确定这种关系的方向和因果关系。作者评估了ATA与HAART治疗依从性之间的纵向关系。分析纳入了意大利初治抗逆转录病毒治疗队列（ICoNA）的AdICoNA和LipolCoNA子研究中的所有参与者。使用一份16项的自填问卷评估依从性，该问卷还包括一个关于过去4周内自我感知脂肪堆积情况的问题。ATA在入组时由医生诊断，并在之后每6个月评估一次。共有207名患者，中位年龄为35岁；73%为男性；34%通过注射吸毒感染艾滋病毒。基线时，63%的参与者报告有不依从情况，15%自我感知有ATA，25%被临床诊断为ATA。使用Cox回归分析，基线时依从性良好的患者更有可能发生ATA（风险比=2.58；95%置信区间，1.09 - 6.11），且发病更早。基线时自我感知的ATA与随后的不依从独立相关（比值比，4.67；95%置信区间，1.01 - 22.4），但临床诊断的ATA并非如此（比值比，0.77；95%置信区间，0.37 - 1.61）。患者对HAART的依从性是一个与ATA相互作用的动态过程。更好的依从性与随后发生ATA的风险较高相关，而患者感知到形态改变的出现会降低对抗逆转录病毒治疗的依从性。
