Biron Antoine, Bobin-Dubigeon Christine, Volteau Christelle, Piroth Lionel, Perré Philippe, Leport Catherine, Prazuck Thierry, Jovelin Thomas, Billard Martine, Sébille Veronique, Bard Jean-Marie, Raffi François, Biron Charlotte
University Hospital Nantes, Laboratory of Virology, Nantes, France.
AIDS Res Hum Retroviruses. 2012 Dec;28(12):1672-8. doi: 10.1089/AID.2012.0048. Epub 2012 Jul 25.
Treatment of HIV infection with highly active antiretroviral therapy can induce metabolic complications and increase the risk of developing the metabolic syndrome (MS). The purpose of this study was to report the prevalence and the risk factors for MS in HIV-infected patients who started highly active antiretroviral therapy (HAART) after 2000. SYMET is a prospective, multicentric, cohort study evaluating the prevalence of MS in 269 patients who had received continuous HAART for 1 to 4 years up to September 2007. MS was defined according to the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) 2005 criteria. Cross-sectional assessment included clinical examination and fasting evaluation of metabolic, inflammatory, and oxidative parameters. Data were analyzed with Chi-square, Student, or Wilcoxon tests. Univariate and multivariate logistic regressions were performed to identify predictive factors for MS. The prevalence of MS was 18.2% after a median duration of HAART of 29.8 months. In multivariate analysis, predictive factors of MS were high non-HDL-cholesterol (OR=1.87; p<0.0001), high-sensitivity C-reactive protein levels (hsCRP) (OR=1.56; p=0.01), coinfection with hepatitis C virus (HCV) (OR=5.67; p=0.02), as well as age (OR=1.04; p=0.02) and duration of exposure to protease inhibitors (PI) (OR=1.03; p=0.02) or to abacavir (ABC) (OR=1.03; p=0.02). In this cohort of patients exposed to less than 4 years of HAART, MS prevalence was 18.2%. Older age, high hsCRP, HCV coinfection, and elevated non-HDL-cholesterol were risk factors for the MS. There was also a moderate significant association of increased risk of MS with cumulative PI and ABC exposure.
采用高效抗逆转录病毒疗法治疗HIV感染可引发代谢并发症，并增加患代谢综合征（MS）的风险。本研究旨在报告2000年后开始接受高效抗逆转录病毒疗法（HAART）的HIV感染患者中MS的患病率及危险因素。SYMET是一项前瞻性、多中心队列研究，评估了截至2007年9月连续接受HAART治疗1至4年的269例患者中MS的患病率。MS根据美国心脏协会（AHA）和美国国立心肺血液研究所（NHLBI）2005年标准进行定义。横断面评估包括临床检查以及对代谢、炎症和氧化参数的空腹评估。数据采用卡方检验、学生检验或威尔科克森检验进行分析。进行单因素和多因素逻辑回归以确定MS的预测因素。HAART中位疗程为29.8个月后，MS的患病率为18.2%。在多因素分析中，MS的预测因素为高非高密度脂蛋白胆固醇（OR=1.87；p<0.0001）、高敏C反应蛋白水平（hsCRP）（OR=1.56；p=0.01）、丙型肝炎病毒（HCV）合并感染（OR=5.67；p=0.02），以及年龄（OR=1.04；p=0.02）和接触蛋白酶抑制剂（PI）（OR=1.03；p=0.02）或阿巴卡韦（ABC）（OR=1.03；p=0.02）的时长。在这一接受HAART治疗少于4年的患者队列中，MS患病率为18.2%。年龄较大、hsCRP水平高、HCV合并感染以及非高密度脂蛋白胆固醇升高是MS的危险因素。MS风险增加与累积PI和ABC接触之间也存在中度显著关联。
