垂直感染 HIV 的儿童和青少年的形态和代谢异常。
Morphologic and metabolic abnormalities in vertically HIV-infected children and youth.
机构信息
Saban Research Institute of Childrens Hospital Los Angeles, University of Southern California, Los Angeles, California, USA.
出版信息
AIDS. 2009 Mar 27;23(6):661-72. doi: 10.1097/QAD.0b013e3283269dfb.
OBJECTIVE
To compare the distribution of lipid and glucose abnormalities and altered fat distribution among vertically HIV-infected patients and controls.
DESIGN
Cross-sectional multicenter study on HIV-infected (HIV-positive) patients, 7-24 years of age, stratified by Tanner stage and protease inhibitor use (protease inhibitor, n = 161 and non- protease inhibitor, n = 79) and seronegative controls (HIV-negative, n = 146).
METHODS
Measurements included fasting lipids, glucose, insulin, 2-h oral glucose tolerance test, dual-energy X-ray absorptiometry, anthropometry, and antiretroviral therapy and medical histories. Multiple linear regression models were used to compare distributions between HIV-positive and HIV-negative groups.
RESULTS
Both HIV-positive groups had long exposures to antiretroviral therapy. Protease inhibitor and nonprotease inhibitor groups had similar current CD4 cell count and HIV-1 RNA, but the protease inhibitor group had lower nadir CD4 cell count, higher peak HIV-1 RNA, and more advanced Centers for Disease Control disease stage. In adjusted analyses, both HIV-positive groups had significantly lower mean Z scores for height, weight, BMI, and total and limb fat than the HIV-negative group. Mean triglycerides were significantly higher and high-density lipoprotein cholesterol lower in both HIV-positive groups relative to the HIV-negative group. The protease inhibitor group also had significantly higher mean total, low-density lipoprotein, and non-high density lipoprotein cholesterol. Mean fasting insulin was higher in both HIV-positive groups, and 2-h glucose and insulin were higher in the protease inhibitor group. Ritonavir was associated with increasing dyslipidemia and altered glucose metabolism.
CONCLUSION
In a large group of vertically HIV-infected children and youth with extensive antiretroviral therapy exposure, height, weight, and total and limb fat were lower than in controls. There was a high prevalence of lipid abnormalities among those on protease inhibitors and evidence of developing insulin resistance, factors that may accelerate lifetime risk for cardiovascular disease.
目的
比较垂直感染 HIV 的患者和对照组之间脂类和糖代谢异常及脂肪分布改变的分布情况。
设计
对感染 HIV（HIV 阳性）的患者进行了一项横断面多中心研究，将患者分为按 Tanner 分期和蛋白酶抑制剂使用情况分层的两个亚组（蛋白酶抑制剂组，n = 161；非蛋白酶抑制剂组，n = 79），以及按血清学结果分层的血清阴性对照组（HIV 阴性，n = 146）。
方法
测量指标包括空腹血脂、血糖、胰岛素、口服葡萄糖耐量试验 2 小时血糖、双能 X 射线吸收法、人体测量和抗逆转录病毒治疗及病史。采用多元线性回归模型比较 HIV 阳性组和 HIV 阴性组之间的分布差异。
结果
两组 HIV 阳性患者均有较长时间的抗逆转录病毒治疗史。蛋白酶抑制剂组和非蛋白酶抑制剂组患者目前的 CD4 细胞计数和 HIV-1 RNA 相似，但蛋白酶抑制剂组患者的 CD4 细胞最低计数更低，峰值 HIV-1 RNA 更高，疾病更晚期。调整分析显示，与 HIV 阴性组相比，两组 HIV 阳性组患者的身高 Z 评分、体重 Z 评分、BMI Z 评分及全身和四肢脂肪量 Z 评分均显著降低。与 HIV 阴性组相比，两组 HIV 阳性组患者的甘油三酯均显著升高，高密度脂蛋白胆固醇水平显著降低。与 HIV 阴性组相比，蛋白酶抑制剂组患者的总胆固醇、低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇水平也显著升高。两组 HIV 阳性组患者的空腹胰岛素水平均升高，且蛋白酶抑制剂组患者的 2 小时血糖和胰岛素水平升高。利托那韦与血脂异常和葡萄糖代谢紊乱的发生相关。
结论
在一组接受大量抗逆转录病毒治疗的垂直感染 HIV 的儿童和青少年中，身高、体重和全身及四肢脂肪量均低于对照组。蛋白酶抑制剂使用者存在很高的脂类异常发生率，且存在胰岛素抵抗的证据，这些因素可能加速患者一生罹患心血管疾病的风险。
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