Mercier Sabine, Gueye Ndeye Fatou Ngom, Cournil Amandine, Fontbonne Annick, Copin Nane, Ndiaye Ibrahima, Dupuy Anne-Marie, Cames Cécile, Sow Papa Salif, Ndoye Ibra, Delaporte Eric, Simondon Kirsten Bork
IRD, UR024, Montpellier, France.
J Acquir Immune Defic Syndr. 2009 Jun 1;51(2):224-30. doi: 10.1097/QAI.0b013e31819c16f4.
To assess adverse effects of long-term highly active antiretroviral therapy (HAART), that is, lipodystrophy and metabolic disorders, in a cohort of African patients.
One hundred eighty HIV-1-infected patients treated with HAART for 4-9 years in Dakar and 180 age-matched and sex-matched controls were enrolled. Regional subcutaneous fat changes were assessed by physicians, and fasting blood samples were drawn. Centralization of body fat was estimated using skinfold ratio, waist circumference, and waist to hip ratio (WHR).
Mean duration of HAART was 5.4 years. Main drugs received were zidovudine, stavudine, and protease inhibitors. The prevalence of moderate-severe lipodystrophy was 31.1% (95% confidence interval: 24.3 to 37.9), with 13.3%, 14.5%, and 3.3% for lipoatrophy, lipohypertrophy, and mixed forms, respectively. Mild-severe lipodystrophy affected 65.0% (58.0; 72.0) of patients. Stavudine was the only independent risk factor (any vs. none: odds ratio = 2.8; 1.4 to 5.5). Patients had lower body mass index and skinfolds but greater centralization of body fat (WHR, P < 0.0001 and skinfold ratio, P < 0.001), fasting glucose (P < 0.0001), homeostasis model assessment insulin resistance, and triglyceride levels (P < 0.01 for both) than controls. Moderately-severely lipodystrophic patients had higher triglyceride and low-density lipoprotein cholesterol than other patients (P < 0.001 and P < 0.05, respectively).
Moderate-severe lipodystrophy affected one third of West African patients on long-term HAART and was associated with a less favorable metabolic profile.
评估非洲患者队列中长期高效抗逆转录病毒治疗（HAART）的不良反应，即脂肪代谢障碍和代谢紊乱。
招募了180名在达喀尔接受HAART治疗4至9年的HIV-1感染患者以及180名年龄和性别匹配的对照者。由医生评估局部皮下脂肪变化，并采集空腹血样。使用皮褶厚度比值、腰围和腰臀比（WHR）评估身体脂肪的向心性分布。
HAART的平均疗程为5.4年。主要使用的药物有齐多夫定、司他夫定和蛋白酶抑制剂。中重度脂肪代谢障碍的患病率为31.1%（95%置信区间：24.3至37.9），其中脂肪萎缩、脂肪增生和混合型分别为13.3%、14.5%和3.3%。轻至重度脂肪代谢障碍影响了65.0%（58.0；72.0）的患者。司他夫定是唯一的独立危险因素（有与无：比值比 = 2.8；1.4至5.5）。患者的体重指数和皮褶厚度较低，但身体脂肪向心性分布更明显（WHR，P < 0.0001；皮褶厚度比值，P < 0.001），空腹血糖（P < 0.0001）、稳态模型评估胰岛素抵抗和甘油三酯水平（两者均P < 0.01）高于对照组。中重度脂肪代谢障碍患者的甘油三酯和低密度脂蛋白胆固醇高于其他患者（分别为P < 0.001和P < 0.05）。
中重度脂肪代谢障碍影响了三分之一接受长期HAART治疗的西非患者，并与较差的代谢状况相关。
