Walmsley Sharon, Cheung Angela M, Fantus George, Gough Kevin, Smaill Fiona, Diong Christina, Raboud Janet
Department of Medicine, University Health Network, Toronto, Ontario, Canada.
HIV Clin Trials. 2008 Sep-Oct;9(5):314-23. doi: 10.1310/hct0905-314.
To prospectively determine incidence, prevalence, and extent of lipodystrophy (LD) and associated metabolic changes.
This was a prospective cohort study. Body habitus changes were determined by anthropometrics, photography, and regional dual-energy X-ray absorptiometry (DXA) scan. Metabolic parameters included triglyceride (TG), total (TC), LDL and HDL cholesterol, glucose, and insulin.
68 patients were included. 51 (75%) received protease inhibitor (PI)-based and 17 (25%) non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ARV) and 90% a thymidine analogue. Statistically significant increases in TC, TG, LDL, and HDL by 12 months developed on PI but only in TC for NNRTI. At 24 months, on DXA scanning, there were no statistically significant changes in median limb or total body fat on NNRTI but a statistically significant decrease in limb fat on PI (p = .01). There was considerable individual variation with overall 3 (7%) patients having >20% increases and 16 (36%) with >20% decreases in limb fat and 6 (14%) having >20% increases and 7 (16%) with >20% decreases in total body fat.
Lipid changes occurred early and progressed. Median changes in body fat were minor and more common on PI, but individual variation in change was large, challenging the use of medians or threshold changes to predict impact of different ARV agents.
前瞻性地确定脂肪代谢障碍（LD）的发病率、患病率及程度，以及相关的代谢变化。
这是一项前瞻性队列研究。通过人体测量学、摄影及区域双能X线吸收测定法（DXA）扫描来确定身体形态变化。代谢参数包括甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白和高密度脂蛋白胆固醇、血糖及胰岛素。
纳入68例患者。51例（75%）接受基于蛋白酶抑制剂（PI）的抗逆转录病毒治疗（ARV），17例（25%）接受基于非核苷类逆转录酶抑制剂（NNRTI）的ARV治疗，90%使用了胸腺嘧啶核苷类似物。在基于PI的治疗中，到12个月时TC、TG、低密度脂蛋白和高密度脂蛋白有统计学意义的升高，但基于NNRTI的治疗仅TC有升高。24个月时进行DXA扫描，基于NNRTI治疗的患者四肢或全身脂肪中位数无统计学意义的变化，但基于PI治疗的患者四肢脂肪有统计学意义的减少（p = 0.01）。个体差异较大，总体上3例（7%）患者四肢脂肪增加>20%；16例（36%）患者四肢脂肪减少>20%；6例（14%）患者全身脂肪增加>20%；7例（16%）患者全身脂肪减少>20%。
脂质变化出现早且持续进展。身体脂肪的中位数变化较小，在基于PI的治疗中更常见，但个体变化差异大，这对使用中位数或阈值变化来预测不同ARV药物的影响提出了挑战。
