van Griensven Johan, De Naeyer Ludwig, Mushi Thomas, Ubarijoro Sowaf, Gashumba Diane, Gazille Claire, Zachariah Rony
Médecins Sans Frontières, Kimihurura, Kacyiru, 1361 Kigali, Rwanda.
Trans R Soc Trop Med Hyg. 2007 Aug;101(8):793-8. doi: 10.1016/j.trstmh.2007.02.020. Epub 2007 Apr 30.
This study was conducted among individuals placed on WHO-recommended first-line antiretroviral therapy (ART) at two urban health centres in Kigali, Rwanda, in order to determine (a) the overall prevalence of lipodystrophy and (b) the risk factors for lipoatropy. Consecutive individuals on ART for >1 year were systematically subjected to a standardised case definition-based questionnaire and clinical assessment. Of a total of 409 individuals, 370 (90%) were on an ART regimen containing stavudine (d4T), whilst the rest were receiving a zidovudine (AZT)-containing regimen. Lipodystrophy was apparent in 140 individuals (34%), of whom 40 (9.8%) had isolated lipoatrophy, 20 (4.9%) had isolated lipohypertrophy and 80 (19.6%) had mixed patterns. Fifty-six percent of patients reported the effects as disturbing. The prevalence of lipoatrophy was more than three times higher when taking d4T compared with AZT-containing regimens (31.4% vs. 10.3%). Being female, d4T-based ART, baseline body mass index >or=25 kg/m(2) or baseline CD4 count >or=150 cells/microl and increasing duration of ART were all significantly associated with lipoatrophy. Lipoatrophy appears to be an important long-term complication of WHO-recommended first-line ART regimens. These data highlight the urgent need for access to more affordable and less toxic ART regimens in resource-limited settings.
本研究在卢旺达基加利的两个城市卫生中心接受世界卫生组织推荐的一线抗逆转录病毒疗法（ART）的个体中进行，目的是确定：（a）脂肪代谢障碍的总体患病率；（b）脂肪萎缩的危险因素。对连续接受ART治疗超过1年的个体系统地进行基于标准化病例定义的问卷调查和临床评估。在总共409名个体中，370名（90%）接受含司他夫定（d4T）的ART方案，其余个体接受含齐多夫定（AZT）的方案。140名个体（34%）出现脂肪代谢障碍，其中40名（9.8%）有单纯性脂肪萎缩，20名（4.9%）有单纯性脂肪增生，80名（19.6%）有混合型。56%的患者报告这些影响令人困扰。与含AZT的方案相比，服用d4T时脂肪萎缩的患病率高出三倍多（31.4%对10.3%）。女性、基于d4T的ART、基线体重指数≥25 kg/m²或基线CD4细胞计数≥150个/微升以及ART治疗时间延长均与脂肪萎缩显著相关。脂肪萎缩似乎是世界卫生组织推荐的一线ART方案的一种重要长期并发症。这些数据凸显了在资源有限的环境中获取更经济实惠且毒性更小的ART方案的迫切需求。
