Ferrando Stephen J, Rabkin Judith G, Lin Shu-Hsing, McElhiney Martin
Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, USA.
AIDS Patient Care STDS. 2005 Apr;19(4):216-23. doi: 10.1089/apc.2005.19.216.
With the advent of potent combination antiretroviral therapy (ART), there has been a reduction in the incidence of wasting. However, few studies have investigated specific body composition changes associated with these treatments. This study aimed to investigate longitudinally the association of increasingly potent ART with changes in body cell mass and wasting utilizing bioelectric impedance analysis (BIA). In this longitudinal cohort study, 159 HIV-positive men were assessed semiannually from 1995 to 1997 for body composition utilizing BIA, CD4 lymphocyte count, HIV viral load, medical and depressive symptoms. Wasting was defined as body cell mass/height below the 90th percentile based on HIV positive norms. ART potency at each visit was scored utilizing published clinical guidelines, ranging from 1 (0-1 antiretrovirals) to 5 (3 or more antiretrovirals including a potent protease inhibitor). Viral resistance testing was not used. The mixed-effects model and the generalized estimating equations approaches were used to determine longitudinal correlates of body cell mass and of wasting, respectively. Over the 2 years of follow-up, potent combination ART use increased from 6% to 79%. Concurrently, a significant increase in mean body cell mass and a reduction in prevalence of wasting were seen, while total body weight, fat mass, and total body water did not change. Increasingly potent ART was associated with significant increases in body cell mass and reduction in wasting. Other significant correlates of increased body cell mass included higher CD4 count and decreased severity of HIV-related symptoms, fatigue and depression. The current study found that higher potency ART taken for relatively short term (2 years) was associated with an increase in body cell mass and a reduction in wasting and that these changes were associated with both medical (CD4, HIV symptoms) and behavioral (fatigue, depression) improvements. One caveat is this study did not distinguish among types of potent ART regimens. Given only some antiretrovirals appear linked to many body composition changes, regardless of their effect on viral load, it may be the type of regimen used that accounted for the relationship seen between viral load and body composition changes.
随着高效抗逆转录病毒联合疗法（ART）的出现，消瘦的发生率有所降低。然而，很少有研究调查与这些治疗相关的特定身体成分变化。本研究旨在利用生物电阻抗分析（BIA）纵向调查效力不断增强的ART与身体细胞质量变化及消瘦之间的关联。在这项纵向队列研究中，1995年至1997年期间每半年对159名HIV阳性男性进行一次评估，利用BIA测量身体成分、检测CD4淋巴细胞计数、HIV病毒载量、记录医疗和抑郁症状。消瘦定义为根据HIV阳性标准，身体细胞质量/身高低于第90百分位数。每次就诊时根据已发表的临床指南对ART效力进行评分，范围从1（0 - 1种抗逆转录病毒药物）到5（3种或更多抗逆转录病毒药物，包括一种强效蛋白酶抑制剂）。未进行病毒耐药性检测。分别使用混合效应模型和广义估计方程方法来确定身体细胞质量和消瘦的纵向相关因素。在2年的随访期间，高效抗逆转录病毒联合疗法的使用从6%增加到79%。与此同时，平均身体细胞质量显著增加，消瘦患病率降低，而总体重、脂肪量和总体水含量没有变化。效力不断增强的ART与身体细胞质量显著增加及消瘦减少有关。身体细胞质量增加的其他显著相关因素包括较高的CD4计数以及HIV相关症状、疲劳和抑郁严重程度的降低。当前研究发现，相对短期（2年）服用效力更高的ART与身体细胞质量增加和消瘦减少有关，并且这些变化与医疗（CD4、HIV症状）和行为（疲劳、抑郁）改善均相关。一个需要注意的是，本研究没有区分高效ART治疗方案的类型。鉴于只有一些抗逆转录病毒药物似乎与许多身体成分变化有关，无论它们对病毒载量的影响如何，可能是所用治疗方案的类型导致了病毒载量与身体成分变化之间所观察到的关系。
