Zannou Djimon Marcel, Denoeud Lise, Lacombe Karine, Amoussou-Guenou Daniel, Bashi Jules, Akakpo Jocelyn, Gougounon Alice, Akondé Alain, Adé Gabriel, Houngbé Fabien, Girard Pierre-Marie
Service de Médecine Interne, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Benin.
Antivir Ther. 2009;14(3):371-80. doi: 10.1177/135965350901400307.
The incidence and risk factors for lipodystrophy and metabolic disorders among patients in Africa on first-line combined antiretroviral treatment (cART) mostly containing non-nucleoside reverse transcriptase inhibitors is poorly documented.
This prospective cohort study recruited 88 HIV-infected patients initiating cART between October 2004 and June 2005 in Cotonou, Benin. Patients were followed for 24 months. The main outcomes were incidence of lipodystrophy and metabolic disorders. Multivariate Cox proportional hazards regression models were used to describe factors associated with progression to lipodystrophy.
After a median follow-up of 23.2 months (interquartile range 22.3-23.7), 24 (30%) patients developed lipodystrophy (lipoatrophy 9%, lipohypertrophy 24% and mixed pattern 2.5%). The incidence rate for lipodystrophy was estimated to 1.72 per person-month (95% confidence interval [CI] 1.15-2.56) occurring after a median time of 11 months on cART. Metabolic syndrome (International Diabetes Federation definition) appeared in 10 (13%) patients after a median of 15 months with an estimated incidence rate of 0.62 per person-month (95% CI 0.33-1.16). It was more common in women (19.2% versus 3.1% in men; P=0.043). Diabetes (8%) and hypercholesterolaemia (35%) were also observed. After adjustment, gender, young age (hazard ratio [HR] 0.45 [95% CI 0.22-0.90]; P=0.025), high BMI at inclusion (HR 1.53 [95% CI 1.28-1.83]; P<0.0001) and smoking (HR 28.0 [95% CI 2.5-307.4]; P=0.006) were significantly associated with lipohypertrophy.
Lipodystrophy and metabolic syndrome were commonly and rapidly observed in this cohort of sub-Saharan patients initiating cART.
在非洲接受一线联合抗逆转录病毒治疗（cART）且大多包含非核苷类逆转录酶抑制剂的患者中，脂肪代谢障碍和代谢紊乱的发病率及风险因素鲜有文献记载。
这项前瞻性队列研究于2004年10月至2005年6月在贝宁科托努招募了88名开始接受cART治疗的HIV感染患者。对患者进行了24个月的随访。主要结局是脂肪代谢障碍和代谢紊乱的发病率。采用多变量Cox比例风险回归模型来描述与脂肪代谢障碍进展相关的因素。
在中位随访23.2个月（四分位间距22.3 - 23.7个月）后，24名（30%）患者出现了脂肪代谢障碍（脂肪萎缩9%，脂肪增生24%，混合模式2.5%）。脂肪代谢障碍的发病率估计为每人每月1.72例（95%置信区间[CI] 1.15 - 2.56），在开始cART治疗的中位时间11个月后出现。代谢综合征（采用国际糖尿病联盟的定义）在中位时间15个月后出现在10名（13%）患者中，估计发病率为每人每月0.62例（95% CI 0.33 - 1.16）。在女性中更常见（19.2%对男性中的3.1%；P = 0.043）。还观察到糖尿病（8%）和高胆固醇血症（35%）。调整后，性别、年轻年龄（风险比[HR] 0.45 [95% CI 0.22 - 0.90]；P = 0.025）、纳入时高体重指数（HR 1.53 [95% CI 1.28 - 1.83]；P < 0.0001）和吸烟（HR 28.0 [95% CI 2.5 - 307.4]；P = 0.006）与脂肪增生显著相关。
在这组开始接受cART治疗的撒哈拉以南患者中，脂肪代谢障碍和代谢综合征常见且出现迅速。
