Guimarães Milena Maria Moreira, Greco Dirceu Bartolomeu, Figueiredo Sônia Maria de, Fóscolo Rodrigo Bastos, Oliveira Antônio Ribeiro de, Machado Lucas José de Campos
Universidade Federal de Minas Gerais, Laboratórios 3063 e 3065, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.
Atherosclerosis. 2008 Dec;201(2):434-9. doi: 10.1016/j.atherosclerosis.2008.02.003. Epub 2008 Feb 15.
To compare high-sensitivity C-reactive protein (hsCRP) in HIV-infected patients treated or not with antiretroviral (ARV) drugs and to correlate hsCRP levels with traditional cardiovascular risk factors and parameters of HIV infection.
One hundred and seventy-one HIV-infected patients were included (129 ARV-treated and 42 ARV-naïve). Evaluations included anthropometric measurements, blood pressure, laboratory tests, ultrasonographic measurement of fat thickness and impedance analysis.
hsCRP levels were higher in ARV-treated compared to ARV-naïve patients (p<0.001). Seventy-two (56%) ARV-treated patients and 11 (26%) ARV-naïve patients had hsCRP concentrations >3 mg/dl (high risk for cardiovascular complications) (OR 3.56; 95%CI: 1.55-8.29; p=0.001, chi(2) test). hsCRP levels correlated positively with waist measurement (p=0.004), waist-to-hip ratio (p<0.001), systolic (p=0.05) and diastolic (p=0.03) blood pressure, intra-abdominal fat thickness (p=0.02), triglycerides (p=0.001), total cholesterol (p=0.01), fasting glucose (p=0.01), and glucose (p<0.001) and insulin levels (p=0.02) measured 2 h after load. No correlation was found between hsCRP levels and CD4 cell counts and HIV-viral load. Independent factors associated with hsCRP levels were therapy with current non-nucleoside reverse transcriptase inhibitors (NNRTI) (p=0.003), waist-to-hip ratio (p=0.006), fasting glucose (p=0.049) and glucose levels 2 h after load (p=0.003) in multivariate analysis model 1 and current NNRTI therapy (p<0.001), protease inhibitor therapy (p=0.016) and cardiometabolic syndrome (p=0.022) in multivariate analysis model 2.
hsCRP in HIV-infected patients is associated with traditional cardiovascular risk factors, principally in ARV-treated patients. hsCRP levels are not associated with CD4 cell counts and HIV-viral load and may constitute a marker for cardiovascular risk related to HIV infection and ARV therapy.
比较接受或未接受抗逆转录病毒（ARV）药物治疗的HIV感染患者的高敏C反应蛋白（hsCRP），并将hsCRP水平与传统心血管危险因素及HIV感染参数进行关联分析。
纳入171例HIV感染患者（129例接受ARV治疗，42例未接受ARV治疗）。评估内容包括人体测量、血压、实验室检查、脂肪厚度超声测量及阻抗分析。
与未接受ARV治疗的患者相比，接受ARV治疗的患者hsCRP水平更高（p<0.001）。72例（56%）接受ARV治疗的患者和11例（26%）未接受ARV治疗的患者hsCRP浓度>3mg/dl（心血管并发症高风险）（比值比3.56；95%置信区间：1.55 - 8.29；p=0.001，卡方检验）。hsCRP水平与腰围（p=0.004）、腰臀比（p<0.001）、收缩压（p=0.05）和舒张压（p=0.03）、腹内脂肪厚度（p=0.02）、甘油三酯（p=0.001）、总胆固醇（p=0.01）、空腹血糖（p=0.01）以及负荷后2小时测量的血糖（p<0.001）和胰岛素水平（p=0.02）呈正相关。未发现hsCRP水平与CD4细胞计数及HIV病毒载量之间存在相关性。在多变量分析模型1中，与hsCRP水平相关的独立因素为当前使用非核苷类逆转录酶抑制剂（NNRTI）治疗（p=0.003）、腰臀比（p=0.006）、空腹血糖（p=0.049）及负荷后2小时血糖水平（p=0.003）；在多变量分析模型2中，相关独立因素为当前NNRTI治疗（p<0.001）、蛋白酶抑制剂治疗（p=0.016）及心脏代谢综合征（p=0.022）。
HIV感染患者的hsCRP与传统心血管危险因素相关，主要见于接受ARV治疗的患者。hsCRP水平与CD4细胞计数及HIV病毒载量无关，可能构成与HIV感染及ARV治疗相关的心血管风险标志物。
