Abraham Alison G, Li Xiuhong, Jacobson Lisa P, Estrella Michelle M, Evans Rhobert W, Witt Mallory D, Phair John
1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
AIDS Res Hum Retroviruses. 2013 Oct;29(10):1346-52. doi: 10.1089/AID.2012.0253. Epub 2013 Jul 9.
In the context of HIV, the initiation of effective antiretroviral therapy (ART) has been found to increase the risk of dyslipidemia in HIV-infected individuals, and dyslipidemia has been found to be a risk factor for kidney disease in the general population. Therefore, we examined changes in lipid profiles in HIV-infected men following ART initiation and the association with future kidney dysfunction. HIV-infected men from the Multicenter AIDS Cohort Study initiating ART between December 31, 1995 and September 30, 2011 with measured lipid and serum creatinine values pre-ART and post-ART were selected. The associations between changes in total cholesterol or high-density lipoprotein following ART initiation and the estimated change in glomerular filtration rate (eGFR) over time were assessed using piecewise linear mixed effects models. There were 365 HIV-infected men who contributed to the analysis. In the adjusted models, at 3 years post-ART, those with changes in total cholesterol >50 mg/dl had an average decrease in eGFR of 2.6 ml/min/1.73 m(2) per year (p<0.001) and at 5 years post-ART, the average decrease was 2.4 ml/min/1.73 m(2) per year (p=0.008). This decline contrasted with the estimates for those with changes in total cholesterol ≤ 50 mg/dl: 1.4 ml/min/1.73 m(2) decrease per year (p<0.001) and 0.1 ml/min/1.73 m(2) decrease per year (p=0.594) for the same time periods, respectively. Large decreases in high-density lipoprotein (a decline of greater than 5 mg/dl) were not associated with declines in eGFR. These results indicate that large ART-related increases in total cholesterol may be a risk factor for kidney function decline in HIV-infected men. Should these results be generalizable to the broader HIV population, monitoring cholesterol changes following the initiation of ART may be important in identifying HIV-infected persons at risk for kidney disease.
在艾滋病毒感染的背景下，已发现启动有效的抗逆转录病毒疗法（ART）会增加艾滋病毒感染者血脂异常的风险，并且血脂异常已被发现是普通人群中肾脏疾病的一个危险因素。因此，我们研究了开始接受抗逆转录病毒治疗后艾滋病毒感染男性的血脂谱变化以及与未来肾功能不全的关联。选取了多中心艾滋病队列研究中在1995年12月31日至2011年9月30日期间开始接受抗逆转录病毒治疗且在治疗前和治疗后测量了脂质和血清肌酐值的艾滋病毒感染男性。使用分段线性混合效应模型评估开始接受抗逆转录病毒治疗后总胆固醇或高密度脂蛋白的变化与随时间推移估计的肾小球滤过率（eGFR）变化之间的关联。共有365名艾滋病毒感染男性参与了分析。在调整后的模型中，抗逆转录病毒治疗后3年，总胆固醇变化>50mg/dl的患者，其eGFR平均每年下降2.6ml/min/1.73m²（p<0.001），抗逆转录病毒治疗后5年，平均每年下降2.4ml/min/1.73m²（p=0.008）。这种下降与总胆固醇变化≤50mg/dl的患者的估计值形成对比：在相同时间段内，分别为每年下降1.4ml/min/1.73m²（p<0.001）和每年下降0.1ml/min/1.73m²（p=0.594）。高密度脂蛋白大幅下降（下降超过5mg/dl）与eGFR下降无关。这些结果表明，抗逆转录病毒治疗相关的总胆固醇大幅升高可能是艾滋病毒感染男性肾功能下降的一个危险因素。如果这些结果能够推广到更广泛的艾滋病毒人群，那么在开始抗逆转录病毒治疗后监测胆固醇变化对于识别有肾脏疾病风险的艾滋病毒感染者可能很重要。
