间歇、CD4 指导的抗逆转录病毒治疗对身体成分和代谢参数的影响。

The effects of intermittent, CD4-guided antiretroviral therapy on body composition and metabolic parameters.

机构信息

Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.

出版信息

AIDS. 2010 Jan 28;24(3):353-63. doi: 10.1097/QAD.0b013e3283333666.

DOI:10.1097/QAD.0b013e3283333666

PMID:20057309

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2902280/

Abstract

OBJECTIVE

To assess the effects of decreased antiretroviral therapy exposure on body fat and metabolic parameters.

DESIGN

Substudy of the Strategies for Management of Anti-Retroviral Therapy study, in which participants were randomized to intermittent CD4-guided [Drug Conservation (DC) group] or to continuous [Viral Suppression (VS) group] antiretroviral therapy.

METHODS

Participants at 33 sites were coenrolled in the Strategies for Management of Anti-Retroviral Therapy Body Composition substudy. Regional fat was assessed annually by whole-body dual-energy X-ray absorptiometry and abdominal computed tomography. Fasting metabolic parameters were assessed at months 4, 8, and annually. Treatment groups were compared for changes in fat and metabolic markers using longitudinal mixed models.

RESULTS

Two hundred and seventy-five patients were randomized to the DC (n = 142) or VS (n = 133) group and followed for a median of 2.0 years. By month 12, limb fat (DC-VS difference 9.8%, 95% confidence interval 3.5-16.1; P = 0.003) and subcutaneous abdominal fat (DC-VS difference 14.3 cm, 95% confidence interval -0.1 to 28.7; P = 0.05) increased in the DC group. There was no treatment difference in visceral abdominal fat (DC-VS difference -2.1%, 95% confidence interval -13.5 to 9.4; P = 0.72). Lipids significantly decreased in the DC group by month 4 and treatment differences persisted throughout follow-up (P < or = 0.001). By 12 months, hemoglobin A1C increased in the DC (+0.3%) and remained stable in the VS group (P = 0.003); the treatment difference remained significant throughout follow-up (P = 0.02).

CONCLUSION

After 12 months, intermittent antiretroviral therapy increased subcutaneous fat, had no effect on visceral abdominal fat, decreased plasma lipids, and increased hemoglobin A1C compared with continuous antiretroviral therapy.

摘要

目的

评估减少抗逆转录病毒治疗暴露对体脂和代谢参数的影响。

设计

Strategies for Management of Anti-Retroviral Therapy 研究的子研究，参与者被随机分配到间歇性 CD4 指导的[药物保留（DC）组]或连续[病毒抑制（VS）组]抗逆转录病毒治疗。

方法

33 个地点的参与者同时参加了 Strategies for Management of Anti-Retroviral Therapy 身体成分子研究。每年通过全身双能 X 射线吸收法和腹部计算机断层扫描评估局部脂肪。在第 4、8 和每年进行空腹代谢参数评估。使用纵向混合模型比较治疗组脂肪和代谢标志物的变化。

结果

275 名患者被随机分配到 DC（n=142）或 VS（n=133）组，并随访中位数为 2.0 年。在第 12 个月时，肢体脂肪（DC-VS 差异 9.8%，95%置信区间 3.5-16.1；P=0.003）和腹部皮下脂肪（DC-VS 差异 14.3cm，95%置信区间 -0.1 至 28.7；P=0.05）在 DC 组增加。在腹部内脏脂肪方面，治疗组之间没有差异（DC-VS 差异 -2.1%，95%置信区间 -13.5 至 9.4；P=0.72）。DC 组的血脂在第 4 个月显著下降，且治疗差异在整个随访期间持续存在（P<或=0.001）。到 12 个月时，DC 组的血红蛋白 A1C 增加（增加 0.3%），VS 组保持稳定（P=0.003）；治疗差异在整个随访期间持续存在（P=0.02）。