Wohl David, Scherzer Rebecca, Heymsfield Steven, Simberkoff Michael, Sidney Stephen, Bacchetti Peter, Grunfeld Carl
AIDS Clinical Trials Unit, University of North Carolina, Chapel Hill, NC, USA.
J Acquir Immune Defic Syndr. 2008 May 1;48(1):44-52. doi: 10.1097/QAI.0b013e31816d9ba1.
HIV infection and antiretroviral therapy are associated with dyslipidemia, but the association between regional adipose tissue depots and lipid levels is not defined.
The association of magnetic resonance imaging-measured visceral adipose tissue (VAT) and regional subcutaneous adipose tissue (SAT) volume with fasting lipid parameters was analyzed by multivariable linear regression in 737 HIV-infected and 145 control men from the study of Fat Redistribution and Metabolic Change in HIV Infection.
HIV-infected men had higher median triglycerides (170 mg/dL vs. 107 mg/dL; P < 0.0001), lower high-density lipoprotein cholesterol (HDL-C; 38 mg/dL vs. 46 mg/dL; P < 0.0001), and lower low-density lipoprotein cholesterol (LDL-C; 105 mg/dL vs. 125 mg/dL; P < 0.0001) than controls. After adjustment, greater VAT was associated with higher triglycerides and lower HDL-C in HIV-infected and control men, whereas greater leg SAT was associated with lower triglycerides in HIV-infected men with a similar trend in controls. More upper trunk SAT was associated with higher LDL-C and lower HDL-C in controls, whereas more lower trunk SAT was associated with higher triglycerides in controls. After adjustment, HIV infection remained strongly associated (P < 0.0001) with higher triglycerides (+76%, 95% confidence interval [CI]: 53 to 103), lower LDL-C (-19%, 95% CI: -25 to -12), and lower HDL-C (-18%, 95% CI: -22 to -12).
HIV-infected men are more likely than controls to have higher triglycerides and lower HDL-C, which promote atherosclerosis, but also lower LDL-C. Less leg SAT and more VAT are important factors associated with high triglycerides and low HDL-C in HIV-infected men. The reduced leg SAT in HIV-infected men with lipoatrophy places them at increased risk for proatherogenic dyslipidemia.
HIV感染及抗逆转录病毒治疗与血脂异常相关，但区域脂肪组织储存与血脂水平之间的关联尚不明确。
在“HIV感染中的脂肪重新分布和代谢变化研究”中，通过多变量线性回归分析了737名HIV感染男性和145名对照男性中磁共振成像测量的内脏脂肪组织（VAT）和区域皮下脂肪组织（SAT）体积与空腹血脂参数的关联。
与对照组相比，HIV感染男性的甘油三酯中位数更高（170mg/dL对107mg/dL；P<0.0001），高密度脂蛋白胆固醇（HDL-C）更低（38mg/dL对46mg/dL；P<0.0001），低密度脂蛋白胆固醇（LDL-C）更低（105mg/dL对125mg/dL；P<0.0001）。调整后，在HIV感染男性和对照男性中，更大的VAT与更高的甘油三酯和更低的HDL-C相关，而在HIV感染男性中，更大的腿部SAT与更低的甘油三酯相关，对照组也有类似趋势。在对照组中，更多的上躯干SAT与更高的LDL-C和更低的HDL-C相关，而更多的下躯干SAT与更高的甘油三酯相关。调整后，HIV感染仍与更高的甘油三酯（升高76%，95%置信区间[CI]：53至103）、更低的LDL-C（降低19%，95%CI：-25至-12）和更低的HDL-C（降低18%，95%CI：-22至-12）密切相关（P<0.0001）。
与对照组相比，HIV感染男性更易出现促进动脉粥样硬化的甘油三酯升高和HDL-C降低，但LDL-C也更低。腿部SAT减少和VAT增加是HIV感染男性甘油三酯升高和HDL-C降低的重要相关因素。有脂肪萎缩的HIV感染男性腿部SAT减少，使其发生致动脉粥样硬化血脂异常的风险增加。
