Tripathi Avnish, Jerrell Jeanette M, Liese Angela D, Zhang Jiajia, Rizvi Ali A, Albrecht Helmut, Duffus Wayne A
1 Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine , Jackson, Mississippi.
Metab Syndr Relat Disord. 2013 Dec;11(6):417-26. doi: 10.1089/met.2013.0017. Epub 2013 Aug 2.
The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART).
The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia.
Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect.
Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.
本研究旨在确定人类免疫缺陷病毒（HIV）感染和未感染的成年回顾性队列中血脂异常的发病率，并评估新发血脂异常与联合抗逆转录病毒疗法（cART）暴露之间的关联。
研究队列包括HIV感染者和一组通过南卡罗来纳医疗补助数据库在1994 - 2011年服务的匹配的未感染HIV个体。与HIV/AIDS监测数据库的关联提供了随时间变化的病毒免疫状态。使用时间依赖性比例风险分析和边际结构模型来评估与新发血脂异常相关的人口统计学、治疗和临床因素。
在13632名中位年龄为39岁的成年人中，接受cART治疗的人群每1000人年血脂异常的总体发病率高于未接受cART治疗的人群以及匹配的未感染HIV组（分别为24.55、14.32和23.23）。多变量结果表明，与未感染HIV的对照组相比，接受cART治疗的HIV感染组血脂异常风险显著更高[调整后风险比（aHR）=1.18；95%置信区间（CI）=1.07 - 1.30]，而未接受cART治疗的HIV感染组风险显著更低（aHR = 0.66；CI = 0.53 - 0.82）。边际结构模型表明，新发血脂异常与基于蛋白酶抑制剂的cART方案[调整率比（aRR）=1.27；CI = 1.08 - 1.49]和基于非核苷类逆转录酶抑制剂的cART方案（aRR = 1.78；CI = 1.19 - 2.66）暴露之间存在显著关联。既往高血压、肥胖和糖尿病会增加血脂异常风险，而丙型肝炎病毒、较低的CD4(+) T细胞计数和较高的HIV病毒载量具有保护作用。
HIV感染早期新发血脂异常较低，但随着cART累积暴露可能显著增加。病毒免疫状态和潜在合并症与血脂异常的发生密切相关。
