Goedecke Julia H, Micklesfield Lisa K, Levitt Naomi S, Lambert Estelle V, West Sacha, Maartens Gary, Dave Joel A
UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
AIDS Res Hum Retroviruses. 2013 Mar;29(3):557-63. doi: 10.1089/aid.2012.0252. Epub 2013 Jan 18.
No African studies have examined the effect of first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and second-line protease inhibitor (PI)-based antiretroviral therapy (ART) on body composition. We compared body composition in HIV-infected black South African women receiving NNRTI-based ART (ART1, n=344), PI-based ART (ART2, n=91), and those not on ART (ART-naive, n=309). Accordingly, body composition was measured using dual energy x-ray absorptiometry (DXA) and anthropometry in a cross-sectional study. Despite similar body mass index (BMI), ART1 and ART2 had greater central fat mass (FM) [median (IQR): 44.2 (39.4-50.1) and 46.9 (39.3-52.8) vs. 41.1 (36.3-45.2) %FM, p<0.01] and less leg FM [41.2 (34.8-45.8) and 40.2 (32.9-45.7) vs. 43.9 (39.3-48.1) %FM, p<0.01] than ART-naive women. Within ART1, waist:hip was greater [0.87 (0.81-0.92) vs. 0.84 (0.78-0.89), p=0.006], while calf skinfold was lower [15.2 (9.4-21.5) vs. 17.4 (12.0-23.6) mm, p=0.033] in women receiving efavirenz compared to nevirapine. ART2 had a greater waist:hip, and abdominal, subscapular, and suprailiac skinfolds than ART1 (p<0.05). After adjusting for time on d4T (stavudine), ART2 had greater body fat than ART1 (p<0.05). With increasing time on d4T, the decrease in leg fat (%FM) was higher in ART1 than ART2 (p=0.012, for time×treatment effect). A similar interaction was reported for total time on ART treatment (p=0.002 for time×treatment effect). In conclusion, ART was associated with increased central fat and reduced peripheral fat. Changing to a PI-based regimen in ART2, which also substitutes stavudine with zidovudine, partially reversed the peripheral fat loss observed on ART1.
尚无非洲地区的研究考察基于一线非核苷类逆转录酶抑制剂（NNRTI）和二线蛋白酶抑制剂（PI）的抗逆转录病毒疗法（ART）对身体成分的影响。我们比较了接受基于NNRTI的ART（ART1，n = 344）、基于PI的ART（ART2，n = 91）的南非感染HIV的黑人女性以及未接受ART的女性（初治，n = 309）的身体成分。因此，在一项横断面研究中，使用双能X线吸收法（DXA）和人体测量法测量身体成分。尽管体重指数（BMI）相似，但与初治女性相比，ART1组和ART2组的中心脂肪量（FM）更高[中位数（IQR）：44.2（39.4 - 50.1）和46.9（39.3 - 52.8） vs. 41.1（36.3 - 45.2）%FM，p<0.01]，腿部FM更低[41.2（34.8 - 45.8）和40.2（32.9 - 45.7） vs. 43.9（39.3 - 48.1）%FM，p<0.01]。在ART1组中，与接受奈韦拉平的女性相比，接受依非韦伦的女性腰臀比更高[0.87（0.81 - 0.92） vs. 0.84（0.78 - 0.89），p = 0.006]，而小腿皮褶厚度更低[15.2（9.4 - 21.5） vs. 17.4（12.0 - 23.6）mm，p = 0.033]。ART2组的腰臀比以及腹部、肩胛下和髂上皮肤褶厚度均高于ART1组（p<0.05）。在调整司他夫定（d4T）使用时间后，ART2组的体脂高于ART1组（p<0.05）。随着d4T使用时间的增加，ART1组腿部脂肪（%FM）的减少幅度高于ART2组（时间×治疗效应，p = 0.012）。在ART治疗总时间方面也报告了类似的交互作用（时间×治疗效应，p = 0.002）。总之，ART与中心脂肪增加和外周脂肪减少有关。ART2组改为基于PI的治疗方案，同时用齐多夫定替代司他夫定，部分逆转了ART1组观察到的外周脂肪减少。
