Jevtović D J, Dragović G, Salemović D, Ranin J, Djurković-Djaković O
Institute for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade University School of Medicine, Belgrade, Serbia.
Biomed Pharmacother. 2009 Jun;63(5):337-42. doi: 10.1016/j.biopha.2008.09.011. Epub 2008 Oct 23.
HAART has dramatically changed the prognosis of AIDS, but has led to long-term toxicities of antiretroviral drugs. A major chronic complication is the metabolic syndrome (MS), including hyperlipidemia, lipodystrophy (LD), and impaired glucose metabolism.
A cross-sectional study of a series of 582 patients from the Serbian HIV/AIDS cohort, treated with HAART for a mean period of 3.3+/-2.1 years (range 1-10), was performed to evaluate the prevalence and risk factors for MS during HAART.
The prevalence of LD was 29.1%, with a 100% probability of development after 10 years of treatment. Risk factors for LD included female gender (OR 1.7, 95% CI 1.0-2.7, P=0.02), age>40 (OR 1.7, 95% CI 1.1-2.7, P=0.01) and AIDS at HAART initiation (OR 1.9, 95% CI 1.2-2.2, P<0.01), as well as prolonged usage of NRTIs (OR 2.7, 95% CI 1.6-4.5, P<0.01). The NNRTI-based regimens were less likely to induce LD than those PI-based (OR 1.87, 95% CI 1.2-2.9 vs. OR 3.7, 95% CI 2.3-6.1, respectively). Hyperlipidemia occurred in 47% of the patients, and was associated with male gender (OR 2.2, 95% CI 1.4-3.5, P<0.01) and prolonged usage of PI+NNRTI HAART (OR 3.0, 95% CI 1.8-4.9, P<0.01). In contrast, regimens composed of 2 NRTI+NNRTI were less likely to induce hyperlipidemia (OR 0.4, 95% CI 0.3-0.7, P=0.03). Glucose intolerance and/or diabetes mellitus was recorded in 9.6%, if with AIDS at HAART initiation (OR 3.7, 95% CI 1.2-11.4, P<0.01), male gender (OR 5.2, 95% CI 1.8-15.1, P<0.01) and age>40 (OR 2.6, 95% CI 1.1-6.3, P=0.02).
MS seems an inevitable consequence of long-term successful HAART.
高效抗逆转录病毒治疗（HAART）显著改变了艾滋病的预后，但导致了抗逆转录病毒药物的长期毒性。一种主要的慢性并发症是代谢综合征（MS），包括高脂血症、脂肪代谢障碍（LD）和糖代谢受损。
对塞尔维亚HIV/AIDS队列中的582例患者进行了一项横断面研究，这些患者接受HAART治疗的平均时间为3.3±2.1年（范围1 - 10年），以评估HAART期间MS的患病率和危险因素。
LD的患病率为29.1%，治疗10年后发生的概率为100%。LD的危险因素包括女性（比值比[OR]1.7，95%置信区间[CI]1.0 - 2.7，P = 0.02）、年龄>40岁（OR 1.7，95% CI 1.1 - 2.7，P = 0.01）以及HAART开始时患有艾滋病（OR 1.9，95% CI 1.2 - 2.2，P<0.01），还有长期使用核苷类逆转录酶抑制剂（NRTIs）（OR 2.7，95% CI 1.6 - 4.5，P<0.01）。基于非核苷类逆转录酶抑制剂（NNRTI）的治疗方案比基于蛋白酶抑制剂（PI）的方案诱导LD的可能性更小（分别为OR 1.87，95% CI 1.2 - 2.9与OR 3.7，95% CI 2.3 - 6.1）。47%的患者发生了高脂血症，其与男性（OR 2.2，95% CI 1.4 - 3.5，P<0.01）以及长期使用PI + NNRTI的HAART方案（OR 3.0，95% CI 1.8 - 4.9，P<0.01）有关。相比之下，由2种NRTI + NNRTI组成的方案诱导高脂血症的可能性更小（OR 0.4，95% CI 0.3 - 0.7，P = 0.03）。9.6%的患者记录有糖耐量异常和/或糖尿病，若HAART开始时患有艾滋病（OR 3.7，95% CI 1.2 - 11.4，P<0.01）、男性（OR 5.2，95% CI 1.8 - 15.1，P<0.01）以及年龄>40岁（OR 2.6，95% CI 1.1 - 6.3，P = 0.02）。
MS似乎是长期成功进行HAART不可避免的后果。
